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HX00033294 


1  IJK    l.()NiT;M)'ORARY 


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RCGOI  MvS"3 

Columbia  (Bniuer^itp 

mtl)eCttp0f39rttigdrk 

College  of  ^t)pfiiiciang  anb  burgeons; 


G-  Ipt"  Op 


Dr.  M.  a.     StARR 


^^ 


'/ 


THE    CONTEMPORARY  SCIENCE    SERIES. 

Edited   by   HAVELOCK  ELLIS. 


SANITY  AND   INSANITY. 


[See  page    53. 


Sanity 
AND    Insanity. 


BY 

CHARLES  MERCIER,  M.B., 

Lecturer  on  Insanity  at  the  Westminster  Hospital  Medical  School^  and  at  the 
]\Iedical  School  for  Women. 


WITH    ILLUSTRATIONS. 


SCRIBNER     &    WELFORD, 

743    &    745    BROADWAY, 

NEW    YORIC 

1890. 


MY   OLDEST  AND   BEST   FRIEND, 

DR.      F.      H.     FORSHALL, 

THIS   BOOK   IS   DEDICATED   IN   GRATEFUL   REMEMBRANCE  OF 

INNUMERABLE  KINDNESSES   RECEIVED 

FROM    HIM. 


CONTENTS. 


CHAPTER  I. 

PAGE 

The  Nervous  System i 


CHAPTER  II. 
The  Nervous  System  {Co?jfi?iued) 25 

CHAPTER  III. 
The  Mind 47 

CHAPTER  IV. 
What  Insanity  is        97 

CHAPTER  V. 
The  Causes  of  Insanity— The  First  Law  of  Heredity    140 

CHAPTER  VI. 

The    Causes    of    Insanity  —  The    Second    Law    of 

Heredity      156 

CHAPTER  VII. 
The  Causes  of  Insanity — Direct  Stress         ...        ...    184 


VHl  CONTENTS. 

CHAPTER  VIII. 

i'AGE 

The   Causes   of   Insanity— Indirect   Stress    of    In- 
ternal Origin       209 

CHAPTER  IX. 

The    Causes   of    Insanity — Indirect  Stress  of    In- 
ternal Origin  {Co?jti??tied)        233 

CHAPTER  X. 

The    Causes  of   Insanity— Indirect    Stress   of  Ex- 
ternal Origin       250 

CHAPTER  XI. 

The  Forms  of  Insanity — Idiocy  and  Imbecility       ...    285 

CHAPTER  XII. 

The    Forms    of    Insaniiy  —  Sleep,    Old    Age,    and 

Drunkenness         298 

CHAPTER  XIII. 
The  Forms  of  Insanity— Melancholia 336 

CHAPTER  XIV. 
The  Forms  of  Insanity— Exaltation    359 

CHAPTER  XV. 
The  Forms  of  Insanity — Dementia        370 

INDEX      391 


LIST  OF   ILLUSTRATIONS. 


BEARDED  WOMAN 

FIG. 

1.  DIAGRAM   OF   LIMB      

2.  ,,  „ 

3.  ENDING  OF  NERVE  IN  MUSCLE 

4.  NERVES       

5.  TRANSVERSE  SECTION  OF  NERVE 

6.  NERVE  FIBRIL       

7.  DIAGRAM  OF  NERVE  CELL  ... 

8.  NERVE  CELL 

9    DIAGRAM   OF   NERVE   SUPPLY  TO   LIMB 


10. 
II. 
12. 

13- 

14. 

16. 


OF  ARRANGEMENT  OF   NERVE   CENTRES 
OF  MARRIAGES   OF   SANGUINITY 


J,  CONSANGUINITY    ... 

NS    OF     NEW-BORN     CHILD,     IDIOT,     AND     NORMAL 


Frontispiece 

PAGE 

4 
4 
6 

7 
8 

9 

14 

15 
20 

22 

23 

157 
158 
158 


BRA 

ADULT  

17.  BRAINS    OF    NEW-BORN    CHILD,     IDIOT, 

ADULT  

18.  CASE   OF  MELANCHOLIA         

19-        »  55  

20.   CASE  OF   PREMATURE   DEMENTIA  ... 


AND    NORMAL 


292 
293 

339 
340 
372 


PREFACE. 


The  other  day  a  corn  merchant  consuhed  me  about  one  of 
his  children  who  had  some  nervous  malady.  "I  took  her,"  he 
said,  "  to  Sir  Omicron  Pie,  and  "  (indignantly)  "  he  gave  her 
bromide  !  "  It  struck  me  as  a  fact  of  remarkable  signifi- 
cance that  a  man  who  was  immersed  all  day  and  all  the  year 
round  in  his  own  business,  should  have  sufficient  knowledge, 
and  sufficient  intelligent  interest,  in  a  somewhat  special 
department  of  a  widely  different  profession,  to  observe  what 
particular  drug  was  ordered  for  his  daughter,  and  to  form 
his  own  judgment  as  to  the  propriety  of  administering  that 
drug  in  that  case.  Thirty  years  ago  such  a  remark  would 
have  been  impossible.  Then  the  medical  man  was  looked 
upon  as  an  oracle,  who  was  regarded  vaguely  and  generally 
as  clever  or  the  reverse,  but  whose  dicta  were  to  be  accepted 
or  rejected  ;  not  criticized.  The  ordinary  intelligent  layman 
gathered  his  notion  of  the  professional  ability  of  his  medical 
adviser  from  general  grounds,  and  not  from  critical  obser- 
vation of  particular  prescriptions.  Nowadays  it  is  different. 
The  patient  and  the  patient's  friends  expect  a  detailed 
description  of  the  precise  seat  and  character  of  the  disorder  ; 
and  what  is  more,  they  consider  themselves  quite  capable  of 
judging  whether  the  explanation  given  is  rational,  and  whether 
the  treatment  is  appropriate.  Medical  terms  are  glibly  used, 
and  medical  theories  are  freely  discussed  in  general  society, 
and  inability  to  join  in  a  medical  discussion  is  regarded  as 
evidence  of  deficiency  of  general  culture.  Society  has  adopted 


Xii  PREFACE. 

the  opinion  of  Melancthon  :  that  it  is  disgraceful  for  a  man 
not  to  know  the  structure  and  composition  of  his  own 
body. 

There  is,  however,  one  department  of  medical  knowledge 
to  which  even  the  most  intelligent  of  laymen  has  not  yet 
gained  access,  and  that  is  the  department  that  deals  with 
insanity.  With  respect  to  this  malady  the  great  majority 
of  medical  men  are  themselves  in  the  position  of  laymen. 
They  have  not  studied  it.  It  was  not  included  in  their 
examinations  ;  it  was  a  thing  outside  their  curriculum — a 
thing  apart,  having  little  community  of  nature  or  similarity 
of  character  with  the  subjects  of  their  professional  studies. 

To  the  outside  layman — to  the  non-medical  public, — 
insanity  presents  itself  in  two  somewhat  contradictory 
aspects.  Sometimes  it  is  to  them  a  matter  of  transparent 
and  childlike  simplicity,  a  thing  which  a  person  of  most 
ordinary  intelligence — say  a  common  juryman — is  capable 
of  estimating  with  accuracy  and  certainty.  At  other  times 
it  is  viewed  much  as  our  ancestors  viewed  the  Black  Art  ; — 
as  something  mysterious  and  marvellous  ;  something  super- 
natural ;  something  to  be  spoken  of  with  bated  breath  ; 
something  too  full  of  awe  to  be  even  named  explicitly.  It 
must  then  be  referred  to  in  indirect  and  elliptical  terms, 
with  pursing  of  the  lips,  with  raised  eyebrows  and  shoulders, 
and  with  shakings  of  the  head. 

Considering  how  common  an  affection  insanity  is  ;  con- 
sidering that  there  is  scarcely  a  family  in  this  country  that 
has  not  had  at  least  one  of  its  members  more  or  less  insane  ; 
it  is  somewhat  remarkable  that  so  little  should  be  generally 
known  about  insanity.  It  is  not,  indeed,  remarkable  that 
this  malady  is  not  discussed  with  the  same  freedom  that 
bodily  diseases  are  talked  of,  for  its  occurrence  is  still  looked 
upon  as  almost  a  disgrace  to  the  family  in  which  it  occurs, 
and  he  who  introduces  the  subject  never  knows  whose  toes 
he  may  be  treading  on.  Nor  is  it  remarkable  that  it  is  not 
discussed  with  that  fulness  of  knowledge  with  which  the 
dyspeptic  legislates    on    dietary,  and    the   materfamilias  on 


PREFACE.  Xlll 

measles  ;  for  even  amongst  experts — the  medical  officers  of 
asylums — the  subject  has  hardly  yet  begun  to  be  scientifi- 
cally studied  ;  so  that  there  is  no  body  of  knowledge  for  the 
layman  to  draw  upon  beyond  a  mass  of  more  or  less  authentic 
anecdotage.  The  eager  interest  with  which  these  anecdotes 
are  received  and  repeated,  shows,  however,  that  there  is 
much  curiosity  alive  upon  the  subject,  and  that  systematic 
information  with  regard  to  it  will  be  received  with  avidity. 
The  dissemination  of  such  information  can  scarcely  fail  to  do 
good  in  several  ways. 

In  the  first  place,  it  may  tend  to  diminish  the  absurd  and 
unreasoning  horror  with  which  insane  people  are  regarded. 
I  have  known  ladies,  in  other  respects  sensible  and  kind- 
hearted,  refuse  to  sit  at  table  with  other  ladies  as  well-bred 
and  well-conducted  as  themselves,  because  the  latter  were 
unsound  in  mind.  And  if  it  were  known,  as  I  trust  it  never 
will  be  known,  that  scarcely  a  week  passes  in  which  I  myself 
do  not  take  a  party  of  lunatics  to  one  or  other  of  the  London 
theatres,  it  is  very  probable  that  those  excellent  places 
of  entertainment  would  find  a  serious  falling-off  in  their 
receipts.  How  often  have  I  not  watched  an  unsuspecting 
stranger  chatting  and  exchanging  criticisms  between  the 
acts  with  one  of  my  companions,  little  thinking  that  for  the 
last  hour  he  had  been  sitting  between  a  couple  of  lunatics, 
and  was  at  that  very  moment  talking  to  one  of  them. 

In  the  second  place,  a  little  familiarity  v/ith  the  pheno- 
mena of  insanity  may  prevent  well-meaning  people  from 
making  idiots  of  themselves  by  talking  of  insane  people  in 
their  presence^  as  if  the  insane  possessed  neither  hearing, 
understanding,  nor  memory.  "  But  does  he  know  that 
he  is  in  an  asylum  ?"  or,  "He  is  not  dangerrnis^  is  he?" 
a  lady  will  ask  (ladies  are  the  chief  offenders  in  this  respect), 
in  the  hearing  and  in  the  presence  of  a  courteous  gentleman 
who  has  been  doing  his  best  to  entertain  her  for  the  last 
half-hour.  She  appears  to  regard  him  as  an  automaton, 
who  acts  and  speaks  by  machinery,  has  no  feelings  to  be 
hurt,  and  is  incapable  of  appreciating  an  insult. 


XIV  PREFACE. 

Thirdly,  a  knowledge  of  the  principles  on  which  insanity 
should  be  regarded  can  scarcely  fail  to  be  of  service  to  that 
large,  and  now  much  increased,  section  of  the  community 
who  have  to  do  officially,  but  as  amateurs,  with  the  insane. 
I  refer  to  the  magistrates  under  the  new  Lunacy  Act,  to 
barristers,  and  others.  The  want  of  knowledge  of  the  rudi- 
ments of  insanity  among  the  general  public  is  remarkable. 
I  have  heard  a  Queen's  Counsel  gravely  tell  a  jury  that  it 
was  against  the  law  for  a  lunatic  to  be  sent  to  an  asylum 
unless  he  (the  lunatic)  was  dangerous.  That  is,  fortunately, 
not  the  law  ;  but  there  are  very  many  people  who  are  strongly 
of  opinion  that  it  ought  to  be  the  law.  A  very  little  know- 
ledge of  lunacy  would  alter  this  opinion.  Apart  from  the 
fact  that  it  is  desirable  to  cure  the  insanity,  and  that  in 
many  cases  a  cure  can  only  be  attempted  within  an  asylum  ; 
apart  from  the  necessity,  that  so  often  exists,  of  secluding  a 
perfectly  harmless  lunatic  in  order  to  prevent  him  from 
squandering  his  means  and  ruining  himself  and  his  family  ; 
apart  from  the  desirability  of  restraining  him  from  perform- 
ing acts  Avhich  are  not  dang&rous,  but  which  are  disgraceful, 
and  which  he  himself  would,  on  his  recovery,  be  loudest  in 
blaming  his  friends  for  not  preventing  ;  there  remains  the 
most  important  fact  that  the  distinguishing  feature  of  the 
insane  is,  not  their  dangerous  aggressiveness,  but  their 
revolting  indecency  and  obscenity.  Of  course,  not  all 
the  insane  are  thus  characterized,  but  a  majority  of 
them,  probably  a  large  majority,  of  both  men  and  women 
are,  or  would  be  if  freed  from  restraint,  more  shameless  and 
filthy  in  their  conduct  than  so  many  monkeys.  It  is  not  merely 
that  the  public  must  be  protected  from  such  conduct  as  this. 
They  have  a  right,  also,  to  be  prevented  from  witnessing  it, 
to  be  protected  from  the  danger  of  witnessing  it  ;  and  it  is 
for  this  reason,  more  than  for  any  other,  that  the  seclusion 
of  the  insane  in  asylums  is  necessary  and  right. 

Lastly,  a  knowledge  of  the  facts  of  insanity  must  be  of 
service  both  to  those  who  are  liable  to  become  insane  and 
to  their  friends,  for  of  this  malady,  more  than  of  any  other, 


PREFACE.  XV 

It  is  true,  that  the  earher  its  beginnings  are  recognized,  the 
better  the  chance  of  prevention  and  the  more  sanguine  the 
hope  of  cure. 

The  present  voknne  is  not,  however,  devoted  mainly,  nor 
even  largely,  to  a  mere  description  of  the  facts  of  insanity. 
That  has  been  done  very  completely  by  people  of  far  longer 
experience,   and  of  better    powers    of  description,    than  are 
possessed    by  the   writer.     In   this  book    the  endeavour   is 
made,  and  is  made,  I  believe,  for  the  first  time,  not  so  much 
to  describe  and  enumerate,  as  to  account  for  the  phenomena 
of  insanity.     That  certain  occurrences  are  occasional,  others 
common,  and  others  invariable  in   insanity,  all  authorities 
are   agreed  ;    and    all   are   agreed,   too,   as  to  the  frequent 
association  of  certain  occurrences  ;  but  so  far  as  I  know,  no 
attempt    has    hitherto    been    made    to    explain    either    the 
occurrence  or  the  association.      For   instance,   it  is  an  old 
observation   that   at  or  about   the    time   of   childbirth  is  a 
common  occasion  for  insanity  to  occur  in  woman.     It  is  an 
old  observation  that  a  melancholy  turn  of  mind  never  occurs 
without  constipation  of  the  bowels.     But  why  these  things 
should  be  associated  together,  what  the  link  may  be  between 
them,  is  a  question  which  not  only  has  never  been  answered, 
but  which,  as  far  as  I  know,  has  never  been  asked.     It  has 
not  occurred  to  any  one  that  an  explanation  was  desirable. 
These,  and   the  other  phenomena  of  insanity,  I  have  en- 
deavoured to  account  for,  in  so  far  as  explanation  in  the 
present  state  of  our  knowledge  appeared  possible,  and  as  far 
as  the  space  at  my  disposal  would  permit. 

The  usual  conception  that  the  laity  have  of  a  lunatic  is 
somewhat  as  follows  :  He  is  usually  raving,  shouting  at  the 
top  of  his  voice,  and  smashing  the  furniture.  When  not  in 
this  state,  he  is  controlling  himself,  and  in  the  plenitude  of 
his  cunning — for  he  is  no  lunatic  if  not  cunning — he  is  lulling 
the  surrounding  people  into  a  sense  of  false  security,  until 
he  can  get  a  convenient  opportunity  of  cutting  their  throats. 
Instead  of  a  hat  he  wears  straws  in  his  hair,  speaks  of 
himself  in  the  third  person,  and  talks  in  ingenious  and 
complicated  parables. 


XVI  PREFACE. 

It  is  hard  to  relinquish  a  simple  faith  that  has  grown  up 
with  us  from  childhood,  and  become  part  of  our  very 
nature  ;  and  for  my  part  I  shall  never  forget  the  shock  it 
was  to  me  Avhen  I  took  office  in  an  asylum  containing  about 
two  thousand  lunatics,  to  find  not  one  single  straw  sticking 
out  of  a  single  head  in  the  institution.  So  far  from  speaking 
in  parables,  they  asked  for  what  they  wanted  with  simple 
directness,  and,  when  they  did  not  get  it,  their  language  was 
as  direct  and  forcible  as  that  of  any  sane  person.  Having 
now  spent  many  years  in  daily  and  hourly  contact  with  the 
insane,  the  one  fact  about  them  which  continually  impresses 
me,  with  more  and  more  conviction,  is  the  wonderfully  little 
difference  that  there  is  between  them  and  other  people.  It 
is  not  merely  that  the  lunatic  is  "fed  with  the  same  food, 
hurt  with  the  same  w^eapons,  subject  to  the  same  diseases, 
healed  by  the  same  means,  warmed  and  cooled  by  the  same 
summer  and  winter,"  as  a  sane  person  ;  but  that  in  his  very 
insanity,  in  the  vagaries  of  his  mind  and  the  extravagancies 
of  his  conduct,  he  exhibits  nothing  but  an  exaggeration  of 
the  same  peculiarities  which  we  all  possess  more  or  less. 

The  reader  should  here  be  warned  that  the  studies  upon 
which  he  is  about  to  enter  are  by  no  means  easy.  Every  one 
admits  that  the  study  of  mind  is  the  highest  and  most 
difficult  branch  of  scientific  inquiry  ;  and  every  biologist 
knows  that  the  elucidation  of  morbid  processes  is  very  far 
more  difficult  than  the  investigation  of  processes  in  their 
healthy  condition.  When,  therefore,  we  come  to  study  the 
morbid  processes  of  mind,  we  enter  upon  investigations  of 
the  very  highest  difficulty. 

In  writing  primarily  for  the  general  reader,  it  will  be  my 
endeavour  to  study,  before  all  things,  plainness  and  intelligi- 
bility, and,  in  order  to  this  end,  it  will  be  necessary  to  take 
nothing  for  granted,  but  to  suppose  that  the  reader  comes 
to  the  study  of  the  subject  with  a  mind  empty,  swept,  and 
garnished  in  so  far  as  a  knowledge  of  the  nervous  system 
and  of  the  mind  is  concerned.     I  shall  assume  that  in  this 


PREFACE.  XVll 

regard  his  mind  is  in  the  condition  symbolized  by  Locke  as 
"  a  sheet  of  blank  paper,"  and  shall  endeavour  to  write 
thereon  a  somewhat  difficult  and  complicated  message  in  a 
fair  round  text. 

The  great  difficulty  that  I  shall  have  to  deal  wath  is, 
how^ever,  that  the  paper  is  not  blank.  It  is  already  scrabbled 
over  with  all  kinds  of  erroneous  notions  ;  and  unless  they 
are  erased  I  shall  only  be  making  a  tangled-looking  palimp- 
sest of  confused  illegibility.  It  will  be  necessary,  therefore, 
to  clear  the  ground  by  eliminating  as  far  as  possible  some 
prevailing  false  doctrines. 

The  next  difficulty  is  in  the  immense  extent  of  the  subject- 
matter.  To  explain  the  whole  of  insanity  requires  a 
preliminary  knowledge  of  neurology,  psychology,  and 
sociology,  and  these  three  sciences  can  scarcely  be  compre- 
hended within  the  limits  of  this  small  volume.  Something 
may,  however,  be  done,  if  conclusions  only  are  given,  while 
the  laborious  processes  by  which  they  have  been  arrived  at 
are  omitted.  Some  of  these  conclusions  are  by  no  means 
universally  accepted  as  yet  ;  but  space  will  not  allow  the 
various  reasons, /7'0  and  co7z,  to  be  adduced,  for  the  reader  to 
form  his  own  judgment  on  them.  Hence  arises  necessity 
for  a  certain  dogmatism.  When  I  am  reasonably  satisfied 
that  a  matter  is  thus  and  so,  thus  and  so  I  shall  state  it  to 
be,  even  if  that  is  not  the  ordinarily  accepted  doctrine.  In 
first  acquiring  knowledge,  it  is  better  for  the  knowledge 
acquired  to  be  erroneous  than  indefinite.  Error  can  be 
corrected,  and  the  more  definite  and  clean-cut  the  error,  the 
easier  the  correction  ;  but  vague,  indefinite,  misty,  formless 
notions  are  much  worse  than  none  at  all.  They  give  their 
possessor  the  confidence  and  pride  of  knowledge  without  the 
substance. 

To  render  clear  what  is  meant,  an  instance  may  be  given. 
It  is  taught  in  this  volume  that  in  order  to  know  anything 
about  insanity  it  is  necessary  first  to  know  something  about 
sanity,  and  that  in  order  to  know  anything  about  the 
disordered  mind  it  is  necessary  to    know  something  about 

I* 


XVlll  PREFACE. 

the  mind  in  health.  In  thus  teaching,  I  am  running  directly 
counter  to  the  opinion  of  many  of  my  professional  brethren, 
one  of  the  most  distinguished  of  whom  has  written  books 
full  of  ridicule  of  this  doctrine.  Still,  I  shall  proceed  as  if 
this  were  a  reasonable  course  to  take,  and  shall  ask  the 
reader  to  accept  the  doctrine  as  a  good  working  hypothesis, 
without  requiring  to  have  the  matter  argued  out  at  length. 

Many  of  the  other  doctrines  here  advanced  are  in  the 
same  position  of  being  unaccepted.  The  statement  of  the 
nature  of  insanity  given  in  Chapter  IV.  was  stated  by  me 
in  thQ  Joiirnal  of  Mental  Science  in  1882,  but  I  do  not 
know  that  it  has  any  adherents.  The  doctrine  of  the 
twofold  causation  of  insanity  is  here  stated  for  the  first  time. 
Some  of  the  biological  doctrines,  e.g.^  that  of  the  parts  taken 
by  the  male  and  female  elements  respectively  in  reproduc- 
tion, are  in  the  same  position,  as  is  the  doctrine  of  the 
double  circulation  of  nerve  energy,  that  of  the  defect  of 
nerve  tension  underlying  melancholia,  and  many  minor 
points.  As  to  the  majority  of  these  doctrines,  I  do  not 
claim  that  they  are  the  true  and  correct  explanation  of 
the  facts  to  which  they  are  applied  ;  but  at  any  rate  they  are 
explanations  of  some  kind.  Their  truth  or  falsity  may  be 
tested  by  working  out  the  consequences  that  they  would,  if 
true,  entail,  and  by  comparing  these  consequences  with  the 
facts.  If  the  hypotheses  stand  this  test,  well  and  good  ;  if 
they  do  not,  let  them  make  way  for  others  that  are  more  in 
harmony  with  the  facts  ;  but  in  any  case  it  seems  to  me  that 
the  time  has  now  arrived,  the  state  of  our  science  has  now 
reached  a  point,  at  which  some  explanation  of  the  facts  of 
insanity  has  become  desirable  ;  and  that  any  hypothesis, 
even  if  erroneous,  is  a  step  towards  the  attainment  of 
truth,  and  is  better  than  a  mere  unorganized  accumulation 
of  facts. 

Some  reference  should  here  be  made  to  the  freedom  with 
which  the  sexual  and  reproductive  functions  are  treated  of  in 
this  volume.  Such  freedom  is  not  customary  in  books  which 
are  not  intended  for  the  exclusive  use  of  the  medical  pro- 
fession ;  but  in   this  case  the  course  taken  is  unavoidable. 


PREFACE.  XIX 

The  phenomena  of  insanity  are  dependent  on,  and  connected 
with,  these  functions  in  so  many  ways,  and  with  so  close  an 
intimacy,  that  to  attempt  to  treat  of  the  former  without 
reference  to  the  latter  would  render  the  book  a  mockery 
and  an  imposture.  Where  it  has  been  necessary  to  refer  to 
these  subjects  they  have  been  treated  of  frankly  and  candidly. 

For  the  photograph  of  the  bearded  woman,  forming  the 
frontispiece,  I  am  indebted  to  my  friend.  Dr.  Ernest  White, 
Superintendent  of  the  City  of  London  Lunatic  Asylum. 

C.  M. 

Henrietta  Street,  Cavendish  Square,  W, 
Ociobei;  1889. 


SANITY  AND   INSANITY, 


CHAPTER  I. 

THE    NERVOUS   SYSTEM. 

If  an  experienced  architect  had  to  give  to  an  intelligent 
nomad  an  exhaustive  description  of  the  structure  of  a  family 
mansion,  he  would  probably  find  that  the  task  before  him 
was  threefold.  He  would  have  to  describe  the  general 
architectural  scheme  of  the  whole  building,  the  appear- 
ance of  the  exterior,  and  the  arrangement  and  uses  of  the 
rooms.  When  this  was  done,  he  would  have  given  but  an 
imperfect  notion  of  the  structure  unless  he  explained  the 
shapes  and  ways  in  Avhich  the  various  materials — the  bricks 
and  mortar,  the  stone  and  timber,  beams,  joists,  rafters, 
floorings  and  skirtings,  the  girders  and  pipes  and  stones 
and  cisterns,  the  panes  of  glass  and  sheets  of  paper — were 
fashioned  so  as  to  fit  into  their  places,  and  contribute  to  the 
stability,  durability,  and  efficiency  of  the  edifice.  Finally, 
he  would  discover  that,  in  addition  to  all  this  instruction,  he 
would  be  obliged  to  explain  the  nature  and  distinctive  pro- 
perties of  each  of  these  materials,  so  as  to  make  clear  to  a 
person  who  had  never  seen  them  the  manner  in  which  they 
are  fitted  to  the  functions  they  severally  have  to  perform. 

As  to  the  order  in  which  the  information  should  be  im- 
parted, the  architect  would  probably  find  that  his  readiest 
way  would  be  to  give  first  a  general  outline  of  the  whole 

Z 


2  SANITY    AND    INSANITY. 

affair,  and  then  to  proceed  in  detail  in  the  inverse  order  of 
that  just  given.  That  is  to  say,  he  would  begin  with  the 
description  of  the  elementary  constituents,  and  then  explain 
the  fabrics  built  up  by  their  combination. 

In  describing  the  elaborate  and  complicated  structure  of 
the  nervous  system  it  will  be  well  to  follow  a  plan  similar  to 
that  which  would  naturally  suggest  itself  in  the  case  sup- 
posed ;  and  though  it  is  unlikely  that  any  reader  will  be  as 
ignorant  of  the  structure  of  the  nervous  system  as  a  Bedouin 
of  that  of  a  house,  yet,  for  the  sake  of  completeness,  it  will 
be  well  to  assume  a  similar  vacuity  of  information,  so  as  to 
begin  at  the  bottom  and  leave  nothing  unexplained. 

To  recur  for  a  moment  to  the  illustration,  it  is  obvious 
that  no  satisfactory  notion  of  the  arrangement  of  a  house 
could  be  given  unless  the  various  uses  of  the  rooms  were 
indicated  in  explanation  of  their  shapes,  sizes,  positions  and 
fittings  ;  and  in  the  same  way,  the  shapes  and  positions  of 
the  various  stones  and  beams  must  account  for  their  proper- 
ties and  uses.  In  other  words,  structure  and  function  must 
be  dealt  with  together  ;  and  with  the  nervous  system  also 
this  course  will  be  found  the  best. 

If  we  cast  a  comprehensive  glance  over  the  whole  of  the 
animal  and  vegetable  kingdoms,  with  a  view  to  determine 
the  quality  or  property  which  most  conspicuously  and 
clearly  distinguishes  the  former  from  the  latter,  we  should 
probably  fix  on  the  presence  or  absence  of  purposive  move- 
ment as  the  most  characteristic  distinction.  It  is  true  that, 
very  low  down  in  the  scale,  there  are  rudimentary  vegetable 
forms  with  considerable  powers  of  movement  that  is  spon- 
taneous, and  may  in  some  cases  appear  purposive  ;  and,  in 
a  similar  position  on  the  other  side,  there  are  sessile  and 
stationary  animal  forms.  It  is  true  also  that  some  of  the 
higher  forms  of  vegetable  life,  such  as  the  droserse,  Venus's 
fly-trap,  and  certain  of  the  orchids,  execute  movements 
which  undoubtedly  subserve  definite  ends.  These  move- 
ments are,  however,  always  movements  of  parts,  often  of 
minute  parts,  and  never  of  the  organism  as  a  whole  j  and 


THE    NERVOUS   SYSTEM.  3 

moreover,  by  the  wonder  with  which  they  are  regarded, 
we  are  assured  of  their  highly  exceptional  character,  and, 
by  the  almost  invariable  comparison  of  them  to  animate 
movements,  we  have  brought  home  to  us  the  universality 
with  which  this  property  of  purposive  movement  is  regarded 
as  an  attribute  special  and  peculiar  to  animal  life. 

The  apparatus  by  which  purposive  movements  are  actuated 
is  the  nervous  system,  and  hence  it  is  to  the  nervous  system 
that  all  animals  are  indebted  for  their  distinctively  animate 
character.  True  it  is  that  there  are  humble  members  of  the 
animal  kingdom  which  possess  no  nervous  system,  and  that 
these  animals  are  capable  of  movement,  and  of  movements 
of  the  entire  organism  ;  but  then  such  movements  are  of 
a  merely  random  character,  and  although  they  may,  and  do, 
effect  certain  purposes,  as,  for  instance,  the  bringing  of  the 
organism  into  contact  with  food,  yet  these  purposes  are 
effected  by  the  mere  fact  of  movement,  and  do  not  necessi- 
tate movement  in  any  specific  direction,  at  any  specific  rate, 
or  of  any  specific  kind.  Scarcely,  therefore,  can  such  move- 
ments be  termed  purposive. 

When  we  raise  our  regard  to  animals  capable  of  move- 
ments that  are  manifestly  purposive,  we  find  that  such 
animals  possess  a  manifest  nervous  system  ;  and  the  more 
definite,  the  more  specific,  the  more  comprehensive,  the 
more  distant,  the  more  elaborate,  the  movement  and  the 
purpose  for  which  it  is  undertaken,  the  more  complex  and 
elaborate — in  other  words,  the  more  highly  evolved — is  the 
nervous  system  by  which  the  movement  is  actuated. 

The  study  of  the  properties  of  the  nervous  system  re- 
solves itself  therefore  mainly  into  a  study  of  the  means  by 
which  it  actuates  movements,  and  of  those  by  which  it 
directs  these  movements  towards  a  definite  end.  I  say 
mainly,  because  the  nervous  system  has  other  and  subsi- 
diary functions  which  will  be  touched  upon  hereafter. 

All  movements  of  animals — that  is  to  say,  of  animals 
sufficiently  elevated  in  the  scale  of  life  to  execute  purposive 
movements — are  directly  actuated  by  muscles.     In  man  the 


4  SANITY   AND   INSANITY 

general  form  and  structure  of  a  muscle  is  that  of  a  more 
or  less  spindle-shaped  bundle  of  fibres,  having  each  end 
fixed  into  a  bone.  Between  the  two  ends  of  the  muscle 
the  continuity  of  the  bone  is  interrupted  by  a  joint  ;  so 
that  one  end  of  the  muscle  is  fixed  into  a  bone  above  a  joint, 
and  the  other  end  into  a  bone  below. 

The  peculiar  and  characteristic  property  of  muscles  is 
their  ability  to  contract  when  they  are  stimulated.  When 
a  muscle  is  stimulated,  it  contracts  ;  that  is  to  say,  it 
shortens  and  thickens,  and  this  shortening  and  thickening 
are  effected  with  great  force,  so  that  the  ends  of  the  muscles, 
and,  Avith  the  ends,  the  bones,  or  whatever  structures  the 


Fig    I  Fig.  2. 

Diagram  representing  tiie  general  relation  of  muscles  to  bones.  B  E,  bones  ; 
J,  joints  ;  M  M',  muscles.  When  M  contracts  and  M'  lengthens,  the 
limb  is  bent,  as  in  Fig  2 


ends  are  attached  to,  arc  brought  together.  In  this  w^ay  all 
bodily  movements  of  every  kind  are  effected,  the  whole  of  our 
ability  to  move  and  act  depending  entirely  on  this  property 
of  contraction  that  belongs  to  muscles ;  the  great  variety  of 
the  movements  that  we  are  able  to  execute,  depending  on 
the  multiplicity  and  variety  of  our  joints,  and  the  various 
ways  in  which  the  muscles  are  disposed  about  them.  By 
far  the  greatest  bulk  of  every  animal  is  composed  of  muscle. 
The  muscles  clothe  the  bones,  and  form  almost  the  whole 
mass  of  the  limbs,  besides  composing  the  fleshy  ridges  on 
each  side  of  the  back,  the  greater  part  of  the  neck,  and  the 
walls  of  the  great  cavities  of  the  chest  and  abdomen. 


THE  np:rvous  system.  5 

All  these  muscles  are  bundles  of  fibres,  and  when  these 
fibres  are  examined,  they  are  found  to  be  themselves  bundles 
of  smaller  fibres  ;  and  these  again  may  be  separated  until  we 
find  that  the  smallest  actual  fibres  are  all  about  the  same 
thickness — all  about  -^^  of  an  inch  in  diameter — and  that 
each  is  enclosed  in  a  fine  pellucid  sheath,  a  mere  film 
wrapped  round  it  to  keep  it  together,  and  that  each  is 
marked  in  a  curious  way  by  crossbars. 

It  has  been  said  that  the  muscle  contracts  only  when 
stimulated^  by  which  is  meant  that  the  contraction  takes 
place  only  when  there  is  an  impact  of  force  upon  the 
muscle.  It  appears  from  experiment  that  any  force — any 
form  of  energy — will  produce  a  contraction  if  it  be  suflfi- 
ciently  powerful,  and  if  it  actually  get  to  the  muscular 
fibres.  We  can  make  a  muscle  contract  by  striking,  or 
pricking,  or  pressing,  or  pinching,  or  burning  it,  or  by 
sending  into  it  a  shock  of  electricity.  But  it  is  found  that 
we  get  no  contraction  unless  there  is  an  impact.  The  con- 
tinuous application  of  a  force  is  of  no  effect.  It  is  only  at 
the  moment  of  impact  that  a  contraction  takes  place  ;  and 
if  we  want  to  keep  up  a  continuous  contraction  we  must 
keep  up  a  rapid  succession  of  shocks  of  some  kind  or  other 
upon  the  muscle. 

When  the  muscle  is  in  its  place,  playing  its  part  in  the 
economy  of  the  living  body,  the  impacts  of  energy  which 
set  it  in  action  are  delivered  to  it  through  the  medium 
of  the  nerves.  When  we  lift  up  one  of  the  muscular 
masses  which  have  been  described,  we  find  that,  in  addi- 
tion to  the  firm  attachment  of  its  ends,  it  has  a  third 
connection  with  the  rest  of  the  body.  At  some  point  we 
shall  find  passing  between  the  bundles  of  fibres  of  which 
the  muscle  consists,  and  entering  the  body  of  the  muscle, 
a  thread  or  string  of  greyish-white  substance.  If  we 
separate  the  bundles  of  fibres  to  see  where  this  string 
goes  to,  we  shall  find  that  it  divides  and  divides  again 
into  a  leash  of  small  threads,  and  that  one  of  these  threads 
goes  into  every  bundle  of  fibres.     If  we  pursue  our  investi- 


6  SANITY   AND   INSANITY. 

gations  further,  by  means  of  the  microscope,  we  shall  find 
that  the  thread  in  the  bundle  divides  again  into  a  leash  of 
small  filaments,  and  that  each  fila-ment  becomes  attached  to 
one  of  the  smallest  fibres  of  which  the  muscle  is  composed. 

If  we  place  under  the  microscope  the  point  of  union  of 
a  nerve-filament  with  a  muscle-fibre,  we  shall  find  that 
the  filament  pierces  the  filmy  sheath  of  the  fibre,  and 
then  spreads  out  into  a  branching  plate,  which  lies  on 
the  surface  of  the  fibre.  There  is  therefore  the  closest 
possible  apposition  between  the  nerve-end  and  the  muscle- 
fibre,  and  in  case  any  force  were  to  traverse  the  nerve-fibre, 
it  w^ould  be  brought  to  impinge  in  the  most  direct  manner 
possible  upon  the  substance  of  the  fibre  of  the  muscle. 

If  we  examine 
again  the  junction  of 
the  nerve  with  the 
muscle-fibre,  we  shall 
see  that  the  former 
also  has  its  filmy 
sheath,  which  be- 
comes continuous 
with  that  of  the 
latter  ;  and  if  we 
trace  the  nerve  fur- 
ther and  further  from  the  muscle-fibre,  we  shall  find  that  the 
former,  like  the  latter,  become  collected  into  bundles,  and  the 
bundles  into  larger  bundles,  all  bound  together  with  the  same 
material  that  binds  the  muscle-fibres,  until  at  last  the  bundle 
becomes  the  considerable  cord  that  we  have  already  seen 
entering  the  body  of  the  muscle.  This  end  of  the  nerve  we 
have  traced  to  its  destination.  We  have  seen  it  dividing  and 
dividing  until  at  last  each  ultimate  filament  terminates  in 
a  plate  in  contact  with  a  muscle-fibre  ;  but  where  does 
the  other  end  go  ?  or  rather,  where  does  this  nerve  come 
from  which  thus  distributes  itself  to  the  ultimate  muscular 
fibres  ?  If  we  trace  the  nerve-string,  we  shall  find  that  it 
goes  towards  the  middle  line  of  the  body  ;  that,  as  it  pro- 


FlG.  3. — Union  of  nerve-end  with  nuisclc-fibre. 


THE    NERVOUS    SYSTEM. 


7 


ceeds,  it  is  joined  by  other  strings  emerging  from  other 
muscles,  until  quite  a  thick  substantial  cord  is  formed  ; 
and  if  we  trace  this  thicker  cord,  we  shall  find  that 
it  passes  through  a  hole  into  a  cavity  which  is  enclosed 
by  the  bones  of  the  skull  and  the  spine,  and  here  it  runs 
into  a  large  mass  of  nervous  matter  shaped  like  a  tadpole, 
the  head  of  the  tadpole  occupying  the  skull,  and  being 
called  the  brain,  while  the  tail  occupies  the  channel  in  the 
spine,  and  is  called  the  spinal  cord  or  spinal  marrow.  It  is 
from  this  mass  of  nerve  tissue 
that   the  pulses  of  energy  Q 

emanate,  which  pass  out 
along  the  nerves  and  set 
the  muscles  in  action. 

The  nerves  which  are  dis- 
tributed to  the  muscles  are, 
however,  not  the  only  ones 
which  issue  from  the  cere- 
bro-spinal  axis.  Large 
nerve-trunks  emerge  from 
the  central  mass  of  nerve 
matter,  and  pass  to  the  eyes, 
to  the  nose,  to  the  tongue, 
to  the  skin,  to  all  the  in- 
ternal viscera,  and  even  to 
the  bones  ;  but  whatever 
their  destination,  the  consti- 
tution of  the  nerve-trunks  pj^^  4.— Portions  of  nerves  showing  the 
is  the  same,  and  their  func-  nerve-fibres  bound  up  in  bundles. 

tion  as  carriers  of  energy, 

or  channels  for  the  passage  of  energy,  is  identical.  There 
is,  however,  this  difference  in  the  function  of  nerves,  that 
while  those  which  go  to  the  muscles,  as  well  as  others  which 
go  to  the  glands  and  some  other  organs,  carry  their  streams 
of  energy  outwards  from  the  great  nervous  masses  to  their 
branched  terminations  at  the  periphery  of  the  body,  the 
nerves  which  connect  the  cerebro-spinal  axis  with  the  skin 


8  SANITY    AND   INSANITY. 

and  the  special  sense-organs  carry  their  currents  of  energy 
from  the  periphery  of  the  body  inwards  to  the  central  masses 
of  nerve-substance. 

Hence  it  appears  that,  just  as  the  body  is  permeated  with 
a  vast  and  intricate  network  of  vessels,  in  which  the  blood  is 
distributed  from  its  central  reservoir,  the  heart,  through 
every  part  of  the  organism  ;  so  it  is  permeated  throughout 
by  an  equally  vast  and  intricate  system  of  nerves,  through 
which  energy  is  distributed  from  the  central  reservoirs,  the 
great  nervous  masses  of  the  brain  and  cord,  throughout  the 
entire  organism. 

The  function  of  the  nervous  system  is  therefore  to  accu- 
mulate and  distribute  energy  ;  but  before  going  into  further 
detail  let  us  be  quite  sure  that  we  clearly 
/^^^^^k        apprehend  what  is  meant  by  the  accu- 
^^^^       mulation    and    distribution    of    energy. 
^G^^jl       Having  definitely  fixed  the  meaning  that 
2S^Mk        we  attach  to  this  phrase,  we  can  then  go 
^^^^^^^         on  to  consider  how  these  functions  can 
be  accomplished — by  what  composition 
E  and  structure  and   mode  of  working  a 

Fig.  5.— Transverse  sec-   tissue  and  a  set  of  organs  become  capable 
tion  of  small  nerve  gf  dealing  with  power,  as  another  set  of 

organs  deal  with  matter. 
Recent  developments  of  mercantile  activity  have  rendered 
it  much  easier  than  it  formerly  was  to  the  non-scientific 
reader  to  gain  a  clear  notion  of  the  storage  and  distribution 
of  energy.  There  is  in  London  a  company  whose  business 
it  is  to  furnish  hydraulic  power  to  its  customers.  From  a 
central  station  is  laid  a  branching  series  of  pipes,  which 
terminate  in  the  various  machines — lifts,  cranes,  presses, 
and  so  forth — which  are  required  to  be  worked.  At  the 
central  station  is  the  pumping  apparatus  by  which  the 
power  is  accumulated,  and  this  power  is  transmitted,  in  the 
form  of  fluid-pressure,  to  the  point  at  which  the  application 
of  the  power  is  needed.  It  will  be  observed  that  although 
the  power  is  transmitted  through  water-pipes,  what  is  trans- 


THE   NKKVOUS   SYSTKM.  9 

mitted  is  not  water,  but  water-pressure — not  matter,  but 
power.  Similarly  there  are  companies  for  the  supply  of  the 
electric  light  At  the  central  station  power  is  accumulated. 
This  power  passes  along  the  wires  in  the  form  of  the  electric 
current,  until  it  reaches  the  carbon  filament  of  the  lamp,  at 
which  it  manifests  itself  to  us  as  light.  In  this  case  there  is 
no  transference  of  matter  along  the  wire  ;  what  passes  is 
power  only.  So  closely  analogous  is  this  storage  and 
transmission  of  energy  to  the  storage  and  transmis- 
sion of  fluid,  that  the  phraseology  and  nomenclature  /^~^ 
of  gas  lighting  have  been  borrowed  and  applied  to  « l^ 
electric  lighting.  These  illustrations  will  render  it 
easy  to  comprehend  clearly  what  is  meant  when  the 
brain  is  spoken  of  as  an  accumulator  and  distributor 
of  energy,  and  the  nerves  as  channels  in  which  energy 
is  conveyed.  It  still  remains  to  show  the  mechanism 
by  which  this  storage  and  carriage  are  effected. 

The  form  of  energy  which  traverses  the  nerves 
is  unique.  Accompanied  by  change  of  temperature, 
yet  it  is  not  heat.  Accompanied  by  electric  changes, 
yet  it  is  not  electricity.  Travelling  in  a  gelatinous 
semi-fluid  medium,  yet  it  is  not  fluid  pressure,  nor 
mere  mechanical  transmission.  It  is  stiz  generis. 
Although,  however,  it  differs  from  every  other  mani- 
festation of  energy  with  which  we  are  acquainted,  it 

is  evidently  diffusible  ;  for  the  nerve  threads  in  which 

•  'Pig   6' 

it  is  transmitted  are  surrounded  or  coated  with  tubes  Nerve*  fibre 

of  oily-looking  material,  whose  function  is,  we  sup-  magnified, 

pose,  to  act  as  an  insulator,  like  the  coating  of    showing 

1  1  •        •  A^r  1      .!-•  filmy  sheath 

gutta-percha  on  an  electric  Wire.    Wemake  this  sup-  containing 
position  because  we  find  this  coating  present  on  those    insulating 
portions  only  of  the  nerve  fibre,  from  which  a  diffu-    material. 
sion  of  the  current  w^ould  be  manifestly  disadvantageous. 
Where  diffusion  would  be  harmless  or  advantageous  there  is 
IK)  such  coating. 

The   circumstances   which   distinguish   the   energy    that 
travels  in  the  nerves  from  other  forms  of  energy  are,  first  of 


lO  SANITY   AND   INSANITY. 

all,  its  rate  of  progress,  nine  metres  per  second  ;  and  secondly, 
the  unique  fact  that  the  current  of  energy  is  cumulative, 
that  is  to  say,  the  further  it  travels  the  stronger  it  gets.  A 
falling  stone  gathers,  it  is  true,  velocity,  and  therefore 
momentum,  both  of  which  become  greater  the  further  it 
falls  ;  but  it  does  not  gain  energy  ;  for  what  it  gains  in  energy 
of  movement  it  loses  in  energy  of  position,  as  is  well  known. 

To  account  for  this  remarkable  property  of  the  nerve 
current,  and  to  explain  the  other  phenomena  of  its  transit, 
the  following  hypothesis  has  been  advanced,  and  since  it 
affords  a  satisfactory  explanation  of  these  and  of  the  other 
facts  of  the  initiation  and  transference  of  nervous  energy,  it  may 
be  regarded  as  the  hypothesis  which  at  present  holds  the  field. 

It  is  known  that  the  molecules  of  which  the  gelatinous 
substance  of  the  nerve  fibres  is  composed  are  of  an  ex- 
tremely complex  structure,  containing,  it  has  been  estimated, 
as  many  as  a  thousand  elementary  atoms  each.  It  is  sup- 
posed that  these  elementary  atoms  cohere  with  various 
degrees  of  closeness  to  the  centre  of  gravity  of  the  mole- 
cule. In  the  interior  of  the  molecule  we  suppose  them  to 
be  firmly  compacted,  and  incapable  of  being  displaced  unless 
the  molecule  is  completely  disintegrated  and  decomposed. 
Supposing  the  atoms  that  make  up  the  molecules  to  be 
arranged  in  layers,  somewhat  like  the  flakes  of  an  onion,  then 
the  innermost  layers  are  the  most  closely  compacted,  while 
as  we  approach  the  surface  the  texture  becomes  looser  and 
looser,  until  the  outermost  layer  is  attached  in  such  a  way, 
that  its  stability  is  upset  with  the  greatest  ease.  The  mole- 
cule is  not,  however,  composed  merely  of  homogeneous  layers 
of  elementary  atoms  arranged  around  a  central  core.  The 
atoms  are  first  combined  together,  say,  in  fours  and  fives  ; 
these  small  groups  are  arranged  into  larger  groups,  the  larger 
groups  into  clusters  of  groups,  until  the  entire  molecule  is  a 
structure  of  much  complication. 

In  building  up  an  elaborate  and  complicated  structure  of 
any  kind,  force  has  to  be  employed  ;  energy  has  to  be  used 
up ;    and    in   this   particular   case,   as   in    other    cases,    the 


THE    NERVOUS    SYSTEM.  H 

energy  which  is  employed  in  building  up  the  structure  is 
converted  from  energy  of  motion  into  energy  of  position,  or, 
as  we  say,  it  is  rendered  latent,  and  remains  latent  in  the  struc- 
ture, ready  to  reappear  and  become  actual  when  the  structure 
is  disarranged.  The  atoms  of  the  molecule  are  bound 
together  and  retained  in  their  position  under  tension.  The 
energy  which  binds  each  of  them  in  its  position  is  much 
like  that  in  a  bent  spring.  When  an  incident  force  impinges 
on  the  molecule  the  atoms  are  displaced,  and  fall  into  simpler 
combinations  ;  and  in  suffering  this  displacement  the  energy 
which  held  them  in  their  constrained  positions  is  liberated, 
and  becomes  available  to  do  work.  It  is  transformed  from 
energy  of  position  into  energy  of  motion.  It  is  as  if  a 
number  of  little  springs  were  suddenly  released  from  their 
bent  position.  The  moment  the  atoms  have  been  released 
from  their  constrained  positions,  and  the  energy  which  held 
them  has  been  set  free  and  made  available  to  do  work,  they 
begin  to  reform  into  their  former  more  complex  positions,  to 
reabsorb  energy  and  to  fit  themselves  for  another  explosion 
upon  the  impact  of  another  shock.  This  rebuilding  of  the 
molecule  is  a  part  of  the  general  function  of  nutrition,  and 
takes  place  in  obedience  to  the  same  laws  as  regulate  the 
building  up  of  the  whole  structure  of  the  body  out  of  the 
materials  of  the  blood. 

The  force  set  free  by  the  falling  of  the  outer  layer  of  atoms 
into  simpler  combinations  becomes  available,  as  has  been 
said,  to  do  work  ;  and  the  first  work  that  it  finds  ready  to 
hand  is  the  disturbance  of  the  second  layer  of  atoms.  If 
sufficient  energy  have  been  liberated  by  the  displacement  of 
the  first  layer,  then  the  more  stably  arranged  atoms  of  the 
second  layer  will  be  displaced,  and  will  liberate  more  energy, 
which  may,  if  sufficient  in  quantity,  upset  the  arrangement 
of  the  next  layer,  and  so  on.  Remembering  that  the  com- 
pactness and  firmness  of  cohesion  of  the  several  layers  of 
atoms  increase  as  we  penetrate  further  toward  the  centre,  it 
will  be  seen  that  a  layer  must  at  length  be  reached  which  is  not 
susceptible  of  disturbance,  and  then  the  discharge  will  cease. 


12  SANITY   AND    INSANITY. 

By  the  disturbance  of  these  several  layers  of  atoms,  a 
certain  quantity  of  energy  is  liberated,  and  becomes  available 
to  do  work  ;  and  just  as  the  energy  liberated  by  one  layer  of 
atoms  tends  to  disturb  and  evoke  energy  from  another  layer 
in  the  same  molecule,  so  the  energy  liberated  from  one  mole- 
cule impinges  upon  its  neighbours,  and  tends  to  upset  their 
atoms  and  to  liberate  energy  from  them.  In  this  outward  as 
in  the  inward  action  of  the  liberated  energy,  it  is  helping 
and  reinforcing  the  effect  of  the  original  impulse  to  which 
its  own  liberation  was  due. 

The  effect  on  the  molecules  of  a  region  will  therefore  be 
similar  to  the  effect  on  the  atoms  of  a  single  molecule.  The 
first  batch  of  molecules  that  is  reached  by  a  wandering  force 
adds  its  quantum  to  the  amount  of  free  energy,  and  the 
wave,  thus  reinforced,  breaks  upon  the  next  layer  of  mole- 
cules with  increased  intensity,  disturbs  them  more  pro- 
foundly, and  gains  an  additional  increment  to  its  own 
volume.  It  is  thus  that  we  account  for  the  increase  in  the 
amount  of  energy  that  accrues  with  each  unit  of  path 
traversed.  To  use  another  similitude,  Ave  may  compare  the 
passage  of  energy  along  a  nerve  to  the  communication  of  an 
impulse  through  a  row  of  billiard  balls  in  contact.  When 
the  nearest  ball  is  struck,  the  impulse  is  communicated  from 
one  to  another  along  the  series,  and  the  last  flies  off  with  an 
impulse  equal  to  that  imparted  to  the  first.  If  we  suppose 
each  ball  not  only  to  pass  on  the  impulse  it  receives,  but 
also  to  add  to  it  a  small  impulse  of  its  own  ;  and  if  we 
further  suppose  that  the  last  ball  parts  with  its  energy 
without  movement  of  translation,  we  shall  have  a  fairly 
accurate  diagram  of  the  passage  of  a  nerve-current. 

So  far  as  the  transmission  of  energy  is  concerned,  the 
above  explanation  is  fairly  complete.  It  still  remains,  how- 
ever, to  discover  the  mechanism  by  which  energy  is  stored 
in  the  great  masses  of  nerve  tissue,  and  liberated  as  required. 

The  supposition  is  that  a  nerve  fibre  is  constituted  oi 
innumerable  molecules  of  the  character  described,  packed 
together  in  a  cylinder.  We  may  regard  the  mode  of  packing 


THE   NERVOUS   SYSTEM.  1 3 

as  being  in  rows  parallel  to  the  axis  of  the  cylinder,  or  in 
strata  transverse  to  the  axis.  The  latter  supposition,  by 
which  the  nerve  fibre  is  looked  on  as  composed  of  a  number 
of  discs  piled  on  one  another,  each  disc  being  made  up  of  a 
single  layer  of  molecules,  is  the  most  convenient  for  the 
present  purpose. 

Now  suppose  that  a  nerve  fibre,  thus  constituted,  expands 
into  a  bulb  or  knob,  similarly  constituted,  and  similarly 
bounded  by  a  coating  impervious  to  the  passing  energy. 
What  will  be  the  result  of  such  an  arrangement  ?  We 
suppose  the  bulb  to  be  made  up,  like  the  fibre,  of  superposed 
discs  ;  but  instead  of  their  diameter  being  uniform,  as  in  the 
fibre,  it  increases  until  the  greatest  diameter  of  the  bulb  is 
reached,  and  then  again  diminishes  until  the  bulb  again 
merges  in  the  fibre,  and  the  discs  resume  their  former 
diameter.^ 

A  wave  of  energy  passing  along  the  fibre  will,  when  it 
reaches  the  bulb,  at  each  step — at  each  successive  disc — 
impinge  upon  a  larger  number  of  molecules,  and  liberate  a 
correspondingly  larger  amount  of  force,  until  the  greatest 
diameter  of  the  bulb  is  reached.  If  the  diameter  of  the  bulb  is 
ten  times  that  of  the  fibre,  then,  when  the  middle  of  the  bulb 
is  reached,  the  face  of  the  advancing  wave  will  have  one  hun- 
dred times  the  area  of  that  in  the  fibre,  the  surface  of  the 
disc  is  one  hundred  times  as  large,  and  the  number  of  dis- 
charging molecules  is  increased  a  hundredfold.  As,  in 
advancing  through  the  bulb  up  to  this  point,  the  area  of  the 
discs  has  been  at  each  step  increasing,  the  discharge  has  at 
each  step  been  passed  on  from  a  smaller  to  a  larger  number 
of  molecules,  and  as  the  discharge  from  each  molecule  has 
therefore  divided  and  passed  on  to  more  than  one  molecule, 
it  follows  that  at  each  step  the  intensity  of  the  discharge  has 
diminished.    But  since  each  molecule  adds  something  to  the 

^  It  is  not  supposed  that  the  fibre  is  actually  composed  of  separate  discs 
in  the  manner  described  ;  but  for  the  purpose  of  tracing  the  progress  of  a 
wave  of  energy  along  the  fibre  it  is  convenient  to  make  this  imaginary 
division  into  discs. 


14 


SANITY   AND   INSANITY. 


discharge,  and  passes  it  on  with  this  added  increment,  it 
follows  that  the  intensity  will  not  diminish  in  proportion  to 
the  spread  of  the  discharge.  In  its  passage  through  the 
second  half  of  the  bulb  the  process  will  be  reversed.  The 
discharge  now  passes  at  each  step  from  a  larger  disc  to  a 
smaller  one  ;  from  a  larger  number  of  molecules  to  a  smaller 
number  ;  and  in  so  doing  it  recovers  the  intensity  that  it 
lost  in  its  passage  through  the  first  half  of  the  bulb.  The 
intensity  of  the  current  on  emergence  will  therefore  be 
equal  to  that  on  entering,  plus  the  small 
increment  that  has  been  added  during  the 
passage.  The  volume  or  magnitude  of 
the  discharge  will,  hoAvever,  have  in- 
creased enormously  ;  for  this  depends  on 
the  number  of  molecules  from  which  it 
proceeds  ;  and  the  number  of  molecules 
in  a  spherical  bulb  of  ten  times  the  dia- 
meter of  a  fibre  will  exceed  the  number 
in  a  length  of  the  fibre,  equal  to  the 
diameter  of  the  bulb,  in  the  proportion 
of  4,183  to  63.  In  other  words,  the  dis- 
charge, in  passing  through  a  bulb  of  ten 
Fig.  7.— Diagram  of  the  units  in  diameter,  has  been  reinforced  by 
relation  of  a  nerve-cell  the  discharge  of  sixty-five  times  as  many 

to    nerve-fibre.      In  ^lolecules  as  would  have  reinforced  it  in 
passing  from  B  to  C  ,  ,  _,  .... 

the  discharge  receives  passing  through  a  fibre  one  unit  in  dia- 

a  reinforcement  sixty-  meter  and  ten  in  length,  and  therefore 

five  times  as  great  as  receives  an  increment  sixty-five  times  as 
inpassingfromAtoB.   ^^^^^       ^^^  ^^^  ^.^^  ^^^^^  ^^  ^^^  ^;^_ 

charge  to  traverse  the  bulb  will  be  equal  to  the  time  taken  to 
traverse  a  length  of  fibre  equal  in  diameter  to  that  of  the 
bulb,  for  in  each  there  are  the  same  number  of  discs,  that  is, 
of  layers  of  molecules,  to  traverse.  So  that  in  the  passage  of 
a  wave  of  energy  through  the  bulb,  sixty-five  units  of  force 
will  be  liberated  in  the  same  time  that  one  unit  would  be 
liberated  in  its  passage  along  an  equal  length  of  fibre.  The 
interposition,  in  the  course  of  a  fibre,  of  such  a  bulb  as  we 


THE   NERVOUS   SYSTEM. 


15 


have  supposed,  would  therefore  have  the  effect  of  adding 
very  largely  to  the  magnitude  of  the  discharge,  and  of  ren- 
dering the  discharge  more  explosive  in  its  character. 

Such  bulbs  as  have  been  described  are  of  very  frequent 
occurrence  in  the  nervous  system.  They  are  termed  nerve- 
cells,  and  number  many  milHons,  each  one,  like  the  fibre  on 
which  it  is  situated,  being  of  microscopic  dimensions.  For 
the  sake  of  simplicity,  the  cell  has  been  spoken  of  as  situated 
in  the  course  of  a  fibre,  but  more  often  the  cells  are  meeting- 
places  of  three  or  more  fibres,  which  again  divide  and 
ramify  at  a  greater  or  less  distance  from  the  cell.     A  dis- 


FiG.  8. — Nerve-cell  connected  with  many  fibres,  highly  magnified. 

charge  communicated  to  any  of  these  distant  branches  will 
travel  along  the  fibre  until  the  cell  is  reached,  when  it  will 
set  up  the  explosive  discharge  already  described,  and  the 
resulting  ebullition  of  energy  will  make  its  escape  by  way 
of  the  various  fibres  into  which  the  cell  is  prolonged. 

From  this  description  it  will  be  evident  that  the  nerve 
cells,  constituted  and  acting  as  has  been  described,  form 
veritable  reservoirs  of  energy,  storing  continuously  in  then- 
intervals  of  repose,  when  their  component  molecules  are 
growing  up   into   more  complex   and   unstable  aggregates, 


1 6  SANITY   AND   INSANITY. 

and  liberating  freely  and  copiously  from  time  to  time  when 
stimulated  by  an  impinging  current. 

Viewed  in  the  mass,  nerve  tissue  is  found  in  the  body  in 
two  chief  forms — as  nerve  trunks,  or,  as  they  are  usually 
termed,  nerves,  and  as  central  masses  of  irregularly  rounded 
form.  The  nerves  are  simply  nerve  fibres  bound  up  together 
in  bundles.  If  we  follow  the  course  of  such  a  bundle  of 
fibres,  we  find  that  in  one  direction  it  separates  into  smaller 
and  smaller  bundles,  until  at  last  the  individual  fibres  run 
alone,  and  end  either  in  muscle  in  the  way  already  described, 
or  in  skin  or  in  some  other  organ.  Followed  in  the  other 
direction,  the  bundle  of  fibres  is  found  to  receive  other 
bundles,  which  become  bound  up  with  it,  and  to  end  at  last 
by  entering  one  of  the  central  masses. 

These  central  masses  of  nerve  substance,  constituting  the 
brain  and  the  spinal  cord,  consist  of  two  different  looking 
substances,  called  respectively  white  matter  and  grey  matter, 
distributed  in  a  very  irregular  manner,  and  forming  very  un- 
equal portions  of  the  nerve  tissue,  the  former  preponderating. 
Examined  microscopically,  the  white  matter  is  found  to 
consist  entirely  of  nerve  fibres  in  every  way  similar  to  those 
of  the  nerve  trunks.  The  grey  matter  is  differently  con- 
stituted. It  is  in  the  grey  matter  alone  that  the  nerve  cells 
are  found,  and  they  are  found  in  immense  numbers.  In 
addition  to  the  cells  and  ramifying  between  them,  the  grey 
matter  contains  an  immense  plexus  or  mesh  of  nerve  fibres, 
which  differ  from  the  fibres  of  the  nerve  trunks  and  of  the 
white  matter,  in  having  no  insulating  jacket.  Many  of 
them  can  be  traced  to  a  junction,  or,  rather,  fusion,  with  a 
nerve  cell.  Others  can  be  followed  till  they  are  found  to 
become  continuous  with  one  of  the  fibres  in  a  nerve  trunk. 
The  vast  majority,  however,  appear  to  terminate  in  one 
direction,  after  branching  again  and  again,  in  free  points  of 
great  tenuity,  embedded  and  lost  in  the  third  chief  con- 
stituent of  the  grey  matter.  This  third  constituent,  the 
matrix  or  ground  substance  of  the  grey  matter,  is  a  homo- 
geneous jelly,  in  which  the  cells  and  fibres  are  embedded, 


THE   NERVOUS    SYSTEM.  17 

and  which  is  closely  similar  in  nature  to  the  substance  of 
which  they  are  composed. 

The  very  highest  importance  attaches  to  this  last  and 
apparently  insignificant  ingredient  of  nervous  matter. 
Regarded  for  a  long  time  as  serving  the  purely  mechanical 
function  of  holding  the  fibres  and  cells  in.  their  places,  it  is 
now  believed  to  be  the  matrix  out  of  which  they  are  formed, 
and  the  medium  by  which  separate  fibres  become  connected 
with  each  other. 

The  entire  matrix  of  the  grey  matter  is  permeable,  though 
with  difficulty,  to  discharges  of  the  same  kind  as  travel  so 
easily  in  the  nerve  fibres  ;  and  these  latter,  as  they  exist  in 
the  grey  matter,  are  regarded  merely  as  channels  of  greater 
permeability  in  a  similar  substance  which  is  less  permeable. 

When  a  discharge  passes  along  a  fibre  thus  embedded,  it 
will  remain  confined  to  the  fibre  so  long  as  the  channel  is  of 
sufficient  calibre  to  carry  it  ;  but  as  the  fibre  diminishes  in 
calibre,  the  intensity  of  the  discharge,  according  to  the  law 
we  have  already  investigated,  will  increase  ;  and  when  the 
discharge  arrives  at  the  fine-pointed  end  of  the  fibre, 
embedded  in  the  slightly  different  matrix,  the  tension  will 
have  reached  a  very  high  degree,  and  will  have  become 
sufficient  to  communicate  the  discharge  to  the  more  stable 
matrix.  In  the  matrix  the  discharge  will  travel  with  more 
difficulty.  Instead  of  travelling  in  a  concentrated  current 
like  water  in  a  pipe,  it  will  travel  in  a  diffused  wave,  like 
the  ripples  on  a  pond,  spreading  wider  as  it  gets  further 
from  the  point  of  origin.  As  the  wave  spreads,  it  will  at 
length  come  in  contact  with  the  pointed  termination  of 
another  nerve  fibre,  and  finding  in  this  direction  a  free 
passage,  the  bulk  of  the  discharge  will  become  concentrated 
towards  this  point  in  the  same  way  that  we  see  water  in  a 
bath  flowing  from  all  sides  towards  the  escape  pipe.  Succeed- 
ing portions  of  discharge  escaping  from  the  first  fibre  will 
tend  to  flow  with  more  and  more  directness  towards  the 
point  of  the  second  fibre,  until  at  length  a  definite  connec- 
tion has  been  established  between  the  two  fibres,  a  definite 


1 8  SANITY   AND   INSANITY. 

channel  has  been  bored  from  the  one  to  the  other,  and  the 
fibres  have  become  practically  continuous.  It  is  in  this  way, 
through  the  intermediation  of  the  slightly  permeable  ground 
substance,  that  distinct  tracts  of  nervous  discharge  are  con- 
nected with  one  another,  and  the  connection  made  structural 
and  permanent.  Let  us  suppose  that  the  discharge  of  one 
tract  of  grey  matter  actuates  one  movement,  say,  of  making 
an  up-stroke  with  the  pen  ;  and  that  another  tract  actuates 
another  movement,  say,  of  making  a  down-stroke.  Then 
the  organic  connection  between  the  two  tracts  that  has  been 
above  described  will  provide  for  the  immediate  occurrence 
of  a  down-stroke  after  an  up-stroke,  provided  the  energy  is 
not  drafted  off  in  some  other  direction,  to  some  other  tract 
of  discharge. 

We  have  supposed  that   the  stream  of  energy  is  flowing 
in  one  direction  across  the  intermediate  tract  of  matrix  from 
the  end  of  one  nerve  fibre  to  the  end  of  another  ;  but  it  is 
obvious  that  both  these  pointed  ends  are  the  ends  of  channels 
along  which  streams  of  energy  habitually  flow  towards  the 
points.     When    a  connection  becomes  established   between 
the  two  points,  it  will  sometimes  happen,  therefore,  that  two 
opposing  streams  will  be  passing  simultaneously  towards  the 
points  ;  will,  now  that  the  channel  is  continued  beyond  the 
points,  pass  on  into  the  intermediate  tract  ;  and  will  at  length 
meet  in  some  intermediate  position.     When  two  opposing 
streams   of  energy   meet   in   this  way,  in  the  course   of  a 
channel  which  is  in  process  of  becoming  a  fibre,  there  will, 
of  course,  be  a  condition  of  very  great  tension  set  up  at  the 
point  of  meeting.     The  energy  will  tend  at  that  point  very 
strongly  to  escape  into  the  surrounding  matrix  on  all  sides, 
and  at  that  point  a  bulging  will  tend  to  occur  in  the  course 
of  the  channel.     As   the    same   thing   happens   time   after 
time,  the  channel  will  at  that  point  bulge  more  and  more, 
until  at  length  a  definite  bulb  is  formed  at  the  spot,  and  the^ 
uniformity  of  the  nerve  fibre  is  interrupted  by  the  inter- 
position in  its  course  of  a  nerve  cell. 

The  disposition  of  these  tracts  of  discharge  with  respect 


THE    NERVOUS    SYSTEM.  l'9 

to  the  parts  of  the  body  that  they  actuate,  and  their  arrange- 
ment with  respect  to  one  another,  are  extraordinarily  com- 
plicated, but  some  idea  of  them  must  be  given,  in  order  to 
render  clear  the  ways  in  which  the  working  of  the  nervous 
system  becomes  deranged  in  insanity  and  other  disorders. 

In  passing  the  tall  warehouses  that  line  certain  of  our 
streets,  we  notice,  projecting-  from  below  the  roof,  the  arm 
of  a  crane,  which  is  used  for  lifting  heavy  goods  from  the 
street  to  the  upper  floor.  When  a  bale  of  goods  has  been 
raised  by  one  of  these  cranes  to  the  necessary  height,  the 
arm  swings  round  on  a  pivot,  and  the  bale  is  deposited  on  a 
projecting  ledge.  If  we  notice  the  man  who  guides  this 
swinging  movement  of  the  crane,  we  observe  that  he  holds 
in  his  hands  two  ropes,  which  pass  over  pulleys,  one  to  the 
right,  the  other  to  the  left,  of  the  crane,  and  are  then 
attached  to  the  extremity  of  the  arm.  In  guiding  the  crane 
round  to  the  right,  he  pulls  on  the  right-hand  rope,  and  at 
the  same  time  pays  the  left-hand  rope  out  to  the  required 
extent.  When  the  crane  has  moved  far  enough,  the  left 
rope  is  checked,  and  the  arm  arrested  at  the  required  point. 
The  advantage  gained  by  the  simultaneous  use  of  the  two 
ropes  is  obvious.  If  only  one  rope  were  used  at  a  time,  the 
arm  could,  it  is  true,  be  swung  round  to  that  side  ;  but  the 
speed  of  its  movement  could  not  be  regulated  with  any 
nicety,  and  the  extent  of  the  movement  could  not  be 
regulated  at  all.  The  arm  of  the  crane  would  either  not 
move  far  enough,  or  it  would  swing  round  until  it  struck  a 
violent  blow  against  the  side  of  the  building. 

The  mechanism  of  the  movements  of  the  body  is  precisely 
similar  to  that  of  the  movements  of  the  crane.  The  vast 
majority  of  our  movements  are  performed  by  the  pull  of  the 
muscles  on  the  bones,  acting,  like  the  ropes  on  the  crane,  on 
levers  of  the  third  order  ;  and  in  the  one  case,  as  in  the 
other,  the  lever,  which  is  moved  by  the  pull  of  a  force  acting 
in  one  direction,  is  steadied  by  the  pull  of  a  lesser  force 
acting  in  the  opposite  direction.  There  is  no  instance  in 
the  body  of  a  muscle  without  an  antagonist  muscle  having 


20 


SANITY   AND   INSANITY. 


a  precisely  opposite  action  ;  and  whenever  a  muscle  begins 
to  contract  and  to  pull  upon  its  point  of  attachment, 
simultaneously  its  antagonist  starts  into  action,  and  begins 
to  pull  in  the  opposite  direction,  so  as  to  steady  and 
smoothen  and  regulate  and  check  the  movement  produced 
by  the  other.  So  that  the  physiological  unit  of  movement 
is  a  pair  of  antagonistic  muscles.  Muscles  are  brought  into 
action  by  the  discharge  of  the  grey  matter  of  the  central 
nervous  system  delivered  through  the  nerve  fibres,  so  that 
in  order  to  produce  such  a  duplex  muscular  action  as  is 
necessary,   there   must    be   some   definite   and   appropriate 


I 

1 


Fig.  9. 

connection   of  a   region   of  grey   matter   Avith  the   nerves 
running  to  the  muscles. 

Suppose  B,  B'  to  be  bones,  connected  by  a  joint  at  J,  and 
having  attached  to  them  two  muscles,  M  and  M',  pulling  in 
opposite  directions.  *  Let  G  be  a  region  of  grey  matter,  and 
N,  N'  nerves  running  from  this  region  to  the  muscles.  G 
is  a  reservoir  of  energy  which  is  discharged  by  some 
impinging  force  whose  origin  we  need  not  now  inquire 
into.  Upon  the  discharge  of  G  a  head  of  pressure  is  set  up 
within  it,  and  the  energy  presses  upon  all  sides  and  seeks  to 
escape.  If  the  outlets  N  and  N'  are  of  equal  calibre,  the 
energy  will  pass  out  by  them  in  equal  amounts,  the  muscles 
will  be  equally  stimulated.,  will  contract  with  equal  force, 


THE    NERVOUS    SYSTEM.  21 

and  the  bone  B  will  not  move,  but  will  become  rigidly 
braced  up  in  its  present  position.  If,  however,  the  outlet 
into  N  is  larger  than  that  into  N',  more  energy  will  escape 
by  N  than  by  N',  the  muscle  M  will  be  more  strongly 
stimulated  than  M',  will  act  more  forcibly,  the  bone  B  will 
move  in  the  direction  of  the  arrow,  and  the  limb  will 
become  more  bent. 

If  the  limb  is  required  to  move  in  the  opposite  direction, 
it  is  evident  that  there  must  be  another  region  of  grey 
matter,  connected  with  the  muscles  by  other  channels,  having 
a  reverse  proportion  to  that  of  N,  N'.  Thus  there  will  be  re- 
quired a  separate  tract  of  grey  matter  for  each  separate  move- 
ment ;  and  each  such  tract  of  grey  matter,  so  connected  with 
muscles  as  to  produce  by  its  discharge  a  definite  movement, 
is  termed  a  nerve  cetitre.  Although  each  movement  requires 
a  separate  centre,  yet  for  each  such  centre  it  will  not  be 
necessary  for  a  separate  pair  of  channels  (nerve  fibres)  to  run 
to  the  muscles.  It  will  be  enough  if  the  outlets  from  the 
centres  into  the  nerves  bear  the  requisite  proportion,  and 
this  being  secured,  the  outlets  can  empty  their  discharge 
severally  into  a  single  pair  of  channels  common  to  all  the 
centres  actuating  that  pair  of  muscles.  Thus,  the  move- 
ment of  the  bone  B  in  the  opposite  direction  to  that  of  the 
arrow^  may  be  actuated  by  a  centre  G'  whose  outlet  into  N' 
is  greater  than  its  outlet  into  N. 

Suppose  now  that  it  is  required  to  bring  into  simultaneous 
action  more  than  one  pair  of  muscles,  as  indeed  frequently 
happens  in  the  execution  of  movements.  In  breathing,  for 
instance,  movements  of  the  chest,  abdomen  and  throat  are 
executed  simultaneously,  and  in  forced  breathing,  as  after 
exercise,  or  when  there  is  some  hindrance  to  the  proper 
aeration  of  the  blood,  it  becomes  necessary  to  move  simul- 
taneously not  only  the  chest,  abdomen,  and  throat,  but  the 
mouth,  nose,  neck,  and  often  the  arms  as  well.  We  have 
seen  that  for  each  pair  or  group  of  antagonistic  muscles 
operating  a  single  movement,  a  separate  nerve  centre  is 
necessary  ;  so   that   for   the  simultaneous  action  of  several 


22  SANITY  AND   INSANITY. 

pairs  of  muscles,  the  simultaneous  action  of  several  nerve 
centres  becomes  necessary.  How  can  the  simultaneous 
discharge  of  several  centres  be  effected  ?  One  obvious 
method  suggests  itself  at  once.  If  the  centres,  whose 
simultaneous  discharge  is  needed,  were  all  connected  with 
another  centre,  then  the  discharge  of  this  other  com- 
mon centre  would  set  all  the  rest  discharging  simul- 
taneously. Suppose  A,  B,  and  C  to  be  three  nerve  centres 
actuating  the  muscles  of  the  chest,  abdomen,  and  throat 
respectively,  by  means  of  the  nerves  a  a^h  h^  and  c  c,  and 
suppose  that  from  each  of  these  centres  there  goes  a  cord  or 
channel  of  communication  to  a  common  centre  at  D.  Then 
the  discharge  of  D  will  set  going  simultaneously  the  dis- 
charges  of  A,   B,    and    C,  and   will  produce   simultaneous 

action  of  the  three  sets  of  antago- 
nistic groups  of  muscles  which  these 
three  centres  represent.  Again, 
the  muscles  of  nose,  neck,  and 
mouth  might  be  represented  in 
three  other  centres,  E,  F,  and 
G,  and  these  be  grouped  together 
Fig.  10.  by  a  central  station  at  H,  and  then 

H  and  D  connected  with  a  still  more  comprehensive  station 
at  I  ;  and  then  the  discharge  of  I  would  bring  about  simul- 
taneous action  of  the  whole  of  the  muscular  apparatus 
employed  in  forced  respiration 

It  is  obvious  that  any  number  of  muscles  can  be  brought 
into  simultaneous  and  duly  proportioned  action  by  a  similar 
arrangement  of  duly  proportioned  channels  proceeding  from 
a  single  centre  ;  and  by  such  an  apparatus  even  the  move- 
ments of  equilibration,  which  demand  simultaneous  and 
duly  proportioned  action  of  almost  all  the  muscles  of  the 
body,  can  be  actuated. 

The  majority  of  our  acts  do  not,  however,  depend  solely 
on  the  simultaneous  action  of  muscles.  In  walking,  for 
instance,  while  a  number  of  muscles  must  act  simultaneously 
to  produce  each  movement  of  each  leg,  yet  these  movements 


THE   NERVOUS   SYSTEM.  23 

would  be  of  little  service  if  they  were  not  timed  to  follow 
one  another  at  proper  intervals.  So  also  in  writing,  in 
speaking,  and  in  every  form  of  handicraft,  while  each  move- 
ment of  arm  and  hand  is  actuated  by  the  simultaneous  pull  of 
many  muscles,  the  conspicuous  factor  in  the  success  of  the 
operation  is  the  nicety  with  which  each  movement  follows 
precisely  in  the  nick  of  time  upon  the  heels  of  its  prede- 
cessor It  is  obvious  that  no  single  discharge  from  any  one 
centre,  however  comprehensive  in  its  control  over  the  body, 
will  account  for  a  sequence  of  movements, — for  the  occur- 
rence of  a  number  of  movements  following  one  another  in 
orderly  succession.  Since  every  movement  requires  the 
discharge   of   a   separate   centre,   sequences   of  movements 


Fig.  II. 

must  necessitate  the  discharge  of  many  centres  in  succession  ; 
and  each  discharge  must  occur  in  its  right  place  in  the 
series,  and  at  the  moment  at  which  the  movement  is  re- 
quired. However  much  the  apparatus  that  we  have  already 
considered  may  be  extended  and  developed,  it  can  never 
assume  a  function  of  which  it  has  not,  as  far  as  we  have 
ascertained,  acquired  even  the  rudiment.  To  fit  it  for  this 
new  function  a  new  factor  is  required. 

Take  as  an  instance  the  action  of  moving  an  object  from 
one  place  to  another.  In  this  case  the  successive  movements 
of  stretching  out  the  arm,  grasping  the  object,  moving  and 
arresting  the  arm,  and  relinquishing  the  grasp,  have  to  be 
made  in  due  order.  If  the  matter  is  considered,  it  will 
become  apparent  that  to  move  the  hand  to  the  object,  the 


24  SANITY    AND    INSANITY. 

guidance  of  sight  is  required.  The  same  aid  is  needed  to 
determine  the  extent  to  which  the  fingers  and  thumb  must 
be  separated  in  order  to  grasp  the  object.  The  amount  of 
approximation  of  the  digits  is  guided  partly  by  sight  and 
partly  by  touch,  and  so  on  of  the  remaining  movements 
that  go  to  complete  the  act. 

Sequences  of  movement  are  regulated,  then,  by  the 
guidance  of  the  senses  ;  but  the  question  is,  What  is  the 
value  of  this  expression,  "  guidance  of  the  senses,"  when 
reduced  to  terms  of  nerve  currents  and  muscular  move- 
ments ?  When  we  say  that  the  sequence  of  movements  is 
effected  under  the  guidance  of  sight,  we  mean  that  the  time 
and  extent  of  the  successive  movements  are  determined  by 
the  impression  made  upon  the  eye  by  light-waves  proceeding 
from  the  object  and  the  other  surrounding  circumstances. 
The  breaking  of  these  waves  on  the  nervous  expansion  at 
the  back  of  the  eye  sets  up  a  certain  leash  of  discharges 
combined  in  certain  ways,  which  start  from  the  expanse  in 
question  and  are  distributed  among  the  centres  in  the  brain. 
As  the  hand  moves  toward  the  object,  the  combination  of 
these  currents  changes  from  moment  to  moment  as  the 
impression  made  in  the  eye  changes,  and,  when  the  hand 
reaches  the  object,  the  grouping  of  the  ingoing  currents  is 
such  that,  when  combined  with  thoce  already  existing,  they 
discharge  the  nerve  region  that  actuates  the  opening  of  the 
hand,  and  that  movement  occurs.  The  new  impression 
produced  by  the  open  hand,  in  definite  and  appropriate 
relation  to  the  object  to  be  seized,  combines  again  with  the 
free  energy  existing  among  the  centres,  switches  it  off  in 
a  new  direction,  and  causes  it  to  break  against  and  discharge 
the  centre  which  actuates  the  closing  of  the  hand,  and  so 
the  process  is  continued.  At  every  step,  the  occurrence  of 
the  appropriate  movement  at  the  proper  time,  and  its  cessa- 
tion after  it  has  performed  its  task,  are  determined  by  the 
leash  of  currents  started  by  an  impression  made  through 
some  of  the  "  avenues  of  sense."  Hence  the  sequences  of 
movements  that  we  can  perform  are  as  infinitely  various  as 
the  circumstances  in  which  we  can  be  placed. 


CHAPTER  II. 

THE  NERVOUS  SYSTEM  [Continued). 

From  the  foregoing  discussion  two  important  conclusions 
stand  out  prominently.  First,  that  while  certain  nerve- 
centres  actuate  movements  directly,  by  discharging  through 
the  nerves  into  the  muscles  ;  there  are  other  centres  which 
actuate  movements  indirectly  by  discharging  into  and  setting 
in  action  the  centres  of  the  first  order.  The  second  conclu- 
sion is  that  the  determination  of  the  special  direction,  and  of 
the  time  of  starting,  of  a  current  into  this  or  that  set  of 
muscles,  is  brought  about  by  the  influence  of  ingoing  cur- 
rents derived  through  the  organs  of  sense  from  the  outside 
world.  These  are  the  two  fundamental  facts  in  the  physio- 
logical constitution  of  the  nervous  system,  and  as  such  they 
will  require  some  further  consideration. 

It  will  be  seen  from  what  has  been  said,  that  the  nerve- 
centres  that  are  in  direct  communication  with  the  muscles 
are  comparatively  few,  and  comprise  those  only  which 
actuate  the  simplest  movements.  The  vast  majority  of  our 
movements  are  actuated  indirectly  by  combinations  of 
simpler  movements,  brought  about  by  the  action  of  secon- 
dary nerve-centres  combining  the  action  of  the  primary 
centres,  and  of  tertiary  and  still  higher  orders  of  centres, 
combining  the  action  of  the  secondary.  The  physiological 
constitution  of  the  nervous  centres  is,  therefore,  it  appears, 
a  hierarchy,  the  members  having  the  simplest  structure 
and  the  rudest  and  most  elementary  functions  being  at  the 
bottom,  and  being  overlaid  by  successive  layers  of  centres, 
the  centres  of  each  layer  becoming  more  complex  and  elabo- 


26  SANITY  AND   INSANITY. 

rate  in  structure,  and  actuating  movements  of  a  more  com- 
plex and  elaborate  character. 

The  more  elevated  the  position  of  a  centre  in  this  hierarchy, 
the  larger  is  the  number  of  centres  whose  functions  it  con- 
trols and  combines ;  and  therefore,  not  only  is  the  movement 
that  it  actuates  of  a  more  complex  and  elaborate  character, 
but  it  affects  a  larger  part  of  the  body.  When  we  arrive  at 
the  highest  layers  of  all,  we  find  centres  which  act  through 
a  number  of  subordinate  ranks  ;  which  actuate  movements 
of  the  utmost  delicacy,  elaborateness,  precision  and  com- 
plexity, and,  most  important  of  all,  which  require  for  their 
proper  performance  a  consensus  of  action  of  every  part  of 
the  body. 

As  the  lowest  centres  act  directly  upon  the  muscles,  the 
movements  that  result  from  their  action  will  be  intense  and 
forcible  ;  while,  as  each,  layer  of  superior  centres  is  separated 
from  the  muscles  by  more  and  more  layers  of  subordinate 
centres,  whose  resistance  has  to  be  overcome  before  any 
movement  can  take  place,  the  discharge  from  the  higher 
centres  will  be  to  some  extent  diffused,  and  will  reach  the 
muscles  in  a  less  intense  and  more  attenuated  form,  and 
will  produce  a  less  forcible  action. 

Again,  while  the  lowest  centres  are  directly  connected 
with  the  muscles  and  have  but  few  lateral  connections  with 
each  other,  the  whole  or  nearly  the  whole  of  their  discharge 
will  be  delivered  into  the  limited  number  of  muscles  that 
they    severally    actuate  ;    the    movement   will    invariably 
follow  the  discharge  ;  there  will  be  little  lateral  diffusion 
of  the  discharge,  and  little  tendency  for  other  movements 
to  occur.     In  the  case  of  the  discharge  of  a  higher  centre, 
however,  on  the  one  hand  the  interposition  of  intermediate 
centres  will  tend  to  oppose  somewhat  the  downward  dis- 
charge into  the  muscles,  and  on  the  other  hand  the  more 
numerous  connections  with  neighbouring  centres  will  open 
more  avenues  for  the  discharge  to  escape  in  other  directions  ; 
and  the  combination  of  these  two  conditions  will  result  in 
a   portion   of    the    discharge    being    diverted    into    lateral 


THE    NKRVOUS   SYSTEM.  27 

channels.  If  the  discharge  is  weak,  so  large  a  portion  of  it 
may  be  thus  drafted  off  that  no  movement  at  all  occurs. 
If  the  discharge  is  powerful,  the  diversion  by  lateral  chan- 
nels into  neighbouring  centres  will  produce  a  tendency  for 
movements  of  allied  character  and  of  neighbouring  parts 
to  accompany  the  movement  directly  actuated.  Upon  dis- 
charge of  the  highest  centres  of  all,  the  movement,  however 
rapid,  can  never  exhibit  the  electric  suddenness  of  the  simple 
movements  actuated  by  the  lowest  centres  ;  it  will  be  of  a 
smoother  and  more  flowing  character.  The  side  connections 
of  these  highest  centres  are  so  numerous,  that  the  opportu- 
nities for  weak  discharges  to  pass  away  without  producing 
movements  will  be  many,  and,  for  the  same  reason,  the  ten- 
dency for  allied  movements  to  occur  will  be  great.  As  the 
discharge  passes  with  ease  from  centre  to  neighbouring 
centre,  so  with  ease  and  celerity  will  movement  follow  allied 
movement. 

In  this  way,  by  the  resistance  which  the  inertia  of  the 
lower  centres  opposes  to  the  disturbance  of  their  equi- 
librium, and  by  the  readiness  with  which  the  discharge  of 
the  higher  centres  can  escape  laterally,  the  action  of  these 
higher  centres  is  to  some  extent  dissociated  from  that  of  the 
lower,  and  from  their  outcome  or  muscular  expression  ;  but 
yet  there  is  in  other  respects  a  very  intimate  association 
between  the  several  strata.  Every  nerve-centre  except  the 
lowest  is  so  connected  with  centres  beneath  it  that  its  dis- 
charge sets  up,  or  tends  to  set  up,  action  of  its  subordinates  ; 
and,  conversely,  every  nerve-centre  except  the  highest  is  so 
connected  with  centres  above  it,  that  it  is,  or  may  be,  set  in 
action  by  their  discharge.  This  statement  expressses,  how- 
ever, only  half  of  the  connection  that  binds  the  several  layers 
of  centres  together  into  an  harmonious,  organized  whole. 

In  addition  to  its  power  of  starting  its  subordinates  into 
activity,  every  centre  maintains,  upon  the  centres  beneath 
it,  a  constant  steadying,  controlling  influence,  by  which  their 
tendency  to  discharge  upon  the  provocation  of  wandering 
forces  is  held  in  check,  and  their  discharge  is  suffered  only 


28  SANITY   AND    INSANITY. 

when  the  superior  centre  transmits  to  them  its  mandate. 
Thus  each  rank  of  centres  is  controlled,  inhibited,  and  held 
in  check  by  the  continuous  influence  of  its  superiors,  and 
each,  in  its  turn,  controls  the  rank  below. 

The  hierarchic  arrangement  of  the  nerve-centres  is  there- 
fore similar  to  that  of  the  officers  of  an  army,  or  the  officials 
of  a  great  business  concern  ;  and,  as  will  be  seen  from  the 
above  description,  very  closely  similar.  Not  only  does  each 
superior  rank  maintain  over  its  subordinates  a  constant 
disciplinary  control,  and  apply  to  them  from  time  to  time  an 
initiatory  stimulus  ;  but  the  lower  ranks  have  authority  and 
control  over  the  fewest  subordinates,  while  the  higher 
govern  the  most,  until  the  highest  centres  of  all  control  the 
entire  organism.  So,  too,  we  have  seen  that  the  higher 
centres  have  a  certain  detachment  from  the  lower,  and  we 
have  now  to  notice  another  aspect  of  this  arrangement. 
The  highest  officials  of  a  business — say,  the  directors  of  a 
gas  company — can  absent  themselves  from  the  business  for 
comparatively  long  intervals  without  seriously  deranging 
the  concern  ;  but  a  strike  of  stokers  is  a  very  serious  matter. 
So,  too,  the  highest  nervous  centres  may  be  out  of  action 
for  hours  together,  as  in  sleep  or  drunkenness,  and  yet  no 
ill  effect  ensue,  but  if  the  nervous  mechanism  of  the  heart 
or  breathing  is  deranged  it  is  a  very  serious  affair.  The 
parallel  that  has  been  suggested  between  the  arrangement 
of  the  nerve-centres  and  that  of  the  officials  of  a  business 
is,  indeed,  so  close  and  so  exact  that  it  can  be  pursued  even 
into  minute  details,  and  in  the  most  various  aspects  of  the 
two  organizations  it  is  found  to  hold  good  with  a  persist- 
ence which  argues  some  community  of  origin  and  of 
nature  between  them.  Such  a  community  indeed  exists, 
for  both  are  organizations  of  similar  materials  which  have 
grown  up  in  obedience  to  the  same  laws,  those  of  evolution, 
to  serve  similar  ends. 

So  far  we  have  considered  the  nervous  system  as  the 
originator,   regulator,   and  controller  of  the  movements  of 


THE    NERVOUS    SYSTEM.  29 

the  body  ;  but  this  view  of  its  functions  is  unduly  Hmited, 
and  in  order  to  represent  truly  the  part  that  it  plays,  our 
concept  requires  to  be  extended. 

The  form  of  energy  which  is  stored  and  distributed  by 
the  nervous  system  is,  so  long  as  it  is  limited  to  the  nervous 
system,  an  affair  of  molecules.  Only  when  it  reaches  the 
muscles  it  does  become  transformed  into  molar  movement. 
Hence  it  is  not  surprising  to  find  that  these  currents  of 
molecular  energy  govern  not  only  the  molar  movements 
of  the  organism,  but  the  molecular  movements  also.  The 
molecular  substitution  of  waste  and  repair  ;  the  detrition  of 
the  tissues,  by  use  and  wear,  into  particles  which  are  washed 
away  by  the  stream  of  blood  that  bathes  all  the  tissues  ; 
the  rebuilding  of  the  wasted  tissues  out  of  material  fur- 
nished to  them  by  the  blood — these  are  processes  whose 
activity  depends  on  the  general  molecular  activity  of  the 
tissue  concerned.  And  the  general  molecular  activity  depends 
on  the  amount  of  molecular  energy  that  reaches  the  part 
through  its  nerves.  When  copious  streams  of  nervous 
energy  are  poured  into  a  tissue  they  arouse  whatever  poten- 
tialities of  action  lie  latent  in  that  tissue.  An  egg  will  lie 
for  days  and  weeks  without  undergoing  any  change  ;  but  let 
it  receive  from  the  parent  bird  a  continuous  and  copious 
supply  of  molecular  energy  in  the  shape  of  heat,  and  its 
latent  potentialities  are  aroused,  its  molecules  undergo 
continuous  re-arrangement,  and  the  chicken  is  formed. 
When  the  bird  leaves  the  nest  and  the  egg  cools,  the  process 
is  arrested.  In  much  the  same  way,  though  with  greater 
directness  and  rapidity,  do  the  streams  of  nervous  energy 
arouse  the  activity,  whatever  it  may  be,  of  the  tissue  into 
which  they  flow  ;  and  in  much  the  same  way  does  this 
activity  abate  when  the  flow  of  the  stream  slackens  and 
ebbs.  On  the  stimulus  of  their  nerve-supply,  not  only  do 
muscle-cells  and  fibres  contract,  but  gland-cells  secrete  or 
eliminate,  and  the  elements  of  every  tissue — bone,  cartilage, 
ligament,  membrane,  skin,  muscle,  gland,  or  what  not — ' 
have  their  molecular  processes  of  waste  and  repair  accele- 


30  SANITY    AND   INSANITY. 

rated  and  invigorated.  Conversely,  when  the  nerve-currents 
become  languid  and  attenuated,  then  the  functions  that 
they  stimulate  and  regulate  are  slackened.  Secretions 
diminish,  excretion  is  retarded,  muscular  action  is  enfeebled, 
nutrition  is  impaired. 

The  control  which  the  nerve-centres  exercise  over  the 
process  of  nutrition  is  subject  to  the  same  laws  as  determine 
their  influence  over  muscular  movement  ;  that  is  to  say, 
the  lowest  centres  control  that  limited  part  of  the  organism 
to  which  their  nerves  are  distributed  ;  but  their  connection 
with  this  limited  part  being  direct,  the  control  they  exercise 
is  absolute,  and  when  their  influence  is  withdrawn  by 
severance  of  the  nerves  or  by  destruction  of  the  centre,  a 
profound  impairment  of  nutrition  ensues,  and  ensues  at 
once.  The  part  so  deprived  of  its  nervous  supply  shrivels  ;  it 
becomes  profoundly  altered  in  appearance  ;  the  whole  process 
of  nutrition  is  retarded,  enfeebled,  and  reduced  to  its  lowest 
ebb.  Parts  may,  and  often  do,  even  die  and  slough  away. 
If  the  injury  occurs  while  the  body  is  growing,  the  growth 
of  the  part  is  retarded  or  altogether  arrested,  and  that  side 
remains  for  the  rest  of  life  smaller  than  the  other. 

If  the  influence  of  an  intermediate  centre  is  withdrawn, 
the  effect  on  nutrition  is  different.  These  centres  are  less 
directly  connected  with  the  periphery  than  the  lowest,  and 
have,  therefore,  a  less  direct  influence  on  nutrition.  More- 
over, if  they  are  destroyed,  there  still  remain  the  centres 
below  them,  which  can  still  perform  some  part  in  regulating 
the  nutrition  of  the  region  supplied  by  them,  although  they 
will  perform  their  part  less  eflftciently  than  before,  and  their 
manner  of  doing  so  will  be  altered  by  the  loss  of  the  regulating 
influence  of  their  superior  centre.  Each  intermediate  centre, 
while  less  directly  actuating  the  nutrition  of  the  region  that 
it  controls,  will  yet,  as  in  the  case  of  movement,  regulate  a 
much  larger  share  of  the  whole  body  than  an  inferior  centre. 
When,  therefore,  an  intermediate  tract  is  destroyed,  the  effect 
on  nutrition  is  not  at  once  discernible,  but  after  a  time  it 
becomes  apparent,  and  is  then  found  to  affect  a  large  area 


THE    NERVOUS    SYSTEM.  3I 

of  the  body.  Instead  of  affecting  a  single  limb,  or  the  legs 
merely,  it  affects  both  arm  and  leg  and  perhaps  a  side  of  the 
face  also.  The  alteration  of  nutrition,  while  it  is  less  imme- 
diate, is  also  less  profound,  and  is  of  a  more  complicated 
character.  In  lieu  of  a  simple  withering  or  sloughing,  there 
is  a  thickening  and  glazing  of  the  skin,  or  an  inflammation 
of  a  joint,  or  a  distortion  of  the  nails,  due  to  some  disturb- 
ance of  their  nutrition. 

When  the  destruction  takes  place  in  the  highest  centres 
of  all,  there  is  always,  as  in  the  case  of  the  inferior  centres, 
a  disturbance  of  nutrition  ;  but  in  this  case  the  obvious  dis- 
turbance is  still  longer  delayed,  it  is  of  a  still  more  complex 
character,  and,  instead  of  being  confined  to  a  limb  or  a  region, 
it  affects  the  whole  of  the  body.  Owing  to  its  less  striking 
and  less  manifest  character,  to  its  tardy  appearance  and 
universal  diffusion,  the  alteration  of  nutrition  that  accom- 
panies disorder  of  the  highest  nervous  centres  is  often  over- 
looked, but  in  every  case  there  will  be  found,  if  searched  for, 
some  discoloration  of  the  skin,  some  excess  or  deficiency  or 
alteration  of  the  perspiration,  some  peculiarity  in  the  growth 
of  the  hair  or  nails,  some  excessive  appetite,  indicative  of 
defective  assimilation  of  food,  or  some  other  evidence  that 
the  process  of  nutrition  is  not  proceeding  normally. 

Throughout  all  the  functions  of  the  nervous  system, 
therefore,  and  from  whatever  point  of  view  these  functions 
are  regarded,  the  hierarchical  principle  prevails. 

The  other  great  principle  of  action  which  has  already 
been  alluded  to  is  also  universally  prevalent.  It  has  been 
shown  that  the  "  determination  of  the  special  direction  and 
the  time  of  starting  of  a  nerve-current  into  this  or  that  set 
of  muscles,  is  brought  about  by  the  influence  of  the  ingoing 
currents,  derived  through  the  organs  of  sense,  from  the 
outside  world,"  and  this  law  holds  good  throughout  the 
entire  range  of  the  nervous  system  from  the  lowest  centres 
to  the  highest. 

To  take,  first,  a  very  simple  case.     A  closure  of  the  eyelids 


32  SANITY   AND    INSANITY. 

can  be  actuated  by  a  mechanism  such  as  has  been  described, 
consisting  of  a  nerve-centre  representing  the  movement,  and 
of  nerves  connecting  this  centre  in  appropriate  ways  with 
the  muscles  by  which  the  movement  is  affected.  Once  set 
in  action,  such  a  mechanism  will  enable  a  closure  of  the  lids 
to  take  place  ;  but  in  order  to  set  it  in  action  the  centre  must 
be  stirred  by  the  impact  of  a  nerve-wave.  When,  therefore, 
an  object  suddenly  approaches  the  eye,  and  the  lids  close 
protectively,  there  must  be  some  arrangement  by  which  the 
approach  of  the  body  can  of  itself  set  the  centre  in  activity. 
The  method  by  which  this  end  is  attained  is  very  simple. 
The  rays  of  light  proceeding  from  the  approaching  body 
pass  through  the  humours  of  the  eye,  and  strike  upon  a 
nervous  expansion  which  is  spread  out  at  the  back  of  it,  and 
which  possesses  just  such  a  degree  of  instability  that  light 
waves  are  sufficient  to  produce  a  discharge  of  its  elements. 
The  discharge  thus  started  is  carried  by  a  nerve  direct  to  the 
centre,  which  actuates  closing  of  the  lids,  and  thus  the 
movement  is  produced  just  at  the  time  that  it  is  needed. 
While  the  greater  part  of  the  ingoing  current  is  absorbed  in 
producing  the  discharge  of  this  centre,  a  certain  portion 
escapes,  and,  reinforced  by  part  of  the  discharge  of  the 
centre,  passes  on  to  higher  strata,  where  it  produces  effects 
that  will  be  considered  later  on. 

For  the  present  we  have  to  notice  (i)  that  the  complete 
nervous  process  consists  of  an  ingoing  current  reaching  the 
centre  ;  a  discharge  of  the  centre  ;  an  outgoing  current  from 
the  centre  to  the  muscles  ;  and  a  fragment  of  discharge 
proceeding  upwards.  (2)  That  this  nervous  process  is  started 
by  an  impression  made  upon  the  organism  from  without, 
and  ends  in  a  muscular  movement.  (3)  That  the  movement 
thus  made  is  appropriate  to  the  circumstances  which  pro- 
duced the  impression.  By  an  appropriate  movement  is 
meant  a  movement  which  is  to  the  advantage  of  the 
organism  ;  either  by  guarding  against,  or  protecting  itself 
against,  or  avoiding  injury  from  the  impressing  circumstance  ; 
or  by  gaining  for  the  organism  some  benefit  from  the  circum- 


THE   NERVOUS   SYSTEM.  33 

Stance.  In  the  above  instance  the  process  is  throughout  of 
the  simplest  character.  The  circumstance  to  be  conformed 
to  is  simple  ;  the  impression  made  on  the  organism  is  simple  ; 
and  the  movement  by  which  the  organism  adapts  itself  to 
the  circumstance  is  simple. 

Let  us  now  take  a  somewhat  more  complex  case.  In  a 
game  of  tennis,  the  movements  of  running  to  and  striking 
the  ball  are  actuated  by  simple  nervous  mechanisms  actuating 
the  muscles  concerned.  The  direction  in  which  the  run  is 
made  is  determined  by  the  nervous  currents  set  up  by  the 
impression  made  by  the  ball,  and  the  direction,  strength,  and 
method  of  the  stroke  are  determined  by  the  group  of  im- 
pressions made  by  the  speed  and  position  of  the  ball,  the 
shape  and  relations  of  the  ground,  and  the  positions  of  the 
adversaries.  In  this  case,  as  in  the  last,  the  nervous  process 
consists  of  ingoing  currents  reaching  the  centres  concerned  ; 
of  discharges  of  the  centres  ;  of  outgoing  currents  from  the 
centres  to  the  muscles  ;  and  of  portions  of  discharge  com- 
municating between  the  centres  immediately  actuating  the 
movements  and  higher  centres.  As  before,  the  process  is 
started  by  an  impression  made  upon  the  organism  from 
without,  and  ends  in  muscular  movement  ;  and  this  is  true 
also  of  each  step  in  the  process.  As  before,  the  movement 
is  appropriate  to  the  circumstances  which  make  the  impres- 
sion. In  the  present  case  the  impression  is  of  a  more 
complex  character,  is  started  by  more  numerous  circum- 
stances, not  merely  by  a  moving  object,  but  by  an  object 
moving  in  certain  definite  surroundings,  which  contribute  to 
the  impression.  The  movement  is  of  a  more  complex 
character.  No  longer  confined  to  a  small  part  of  the 
organism  it  implicates  the  whole  of  it.  The  whole  process, 
while  similar  in  character  to  that  in  the  previous  instance,  is 
throughout  more  complicated  in  form. 

It  is  clear,  however,  that  there  is  some  other  factor  in 
producing  the  movements  in  the  game  of  tennis  beyond 
those  that  we  have  considered.  For  the  same  impressions 
that  evoke  the  movements  of  the  players  are  made  upon  the 

4 


34  SANITY   AND   INSANITY. 

spectators,  yet  in  them  no  answering  reaction  is  called  forth. 
They  sit  still  and  take  no  part  in  the  game.  What  is  the 
factor  that  has  been  neglected  ?  It  is  to  be  found  in  that 
hitherto  unconsidered  part  of  the  nerve  current  which  has 
been  spoken  of  as  communicating  between  the  centres 
actuating  the  movements  and  centres  of  a  higher  order. 
While  each  individual  movement  is  started  by  an  individual 
impression,  and  while  the  movements  are  modified  from 
moment  to  moment  by  impressions  momentarily  arriving, 
the  entire  series  of  movements  is  permitted  by  the  general 
removal  of  inhibition  from  the  whole  group  of  centres 
immediately  concerned, — an  inhibition  actuated,  as  already 
described,  by  centres  of  a  higher  order,  and  loosened  by  an 
alteration  in  their  mode  of  action. 

At  this  point  we  are  again  confronted  with  the  problem  of 
initiation.  What  influence  is  it  that  starts  these  higher 
centres  into  action,  and  causes  them  to  remove  from  their 
inferiors  their  inhibitory  influence  ?  Again  the  same  solution 
applies.  It  is  the  arrival  of  impressions  from  without,  it  is 
the  meeting  of  the  players  and  the  arrangement  made 
among  them  for  the  playing  of  the  game.  In  this  case  also 
there  is  an  impression  from  without  upon  the  organism  ; 
there  is  the  discharge  of  a  nerve  tract  ;  and  there  is  the 
issue  of  this  discharge  in  the  liberation  of  movement.  But 
in  this  case  we  observe  a  new  element  introduced  into  the 
reaction.  In  the  previous  cases  the  reaction  was  direct  and 
was  immediate.  In  the  present  case  the  reaction  is  indirect, 
is  delayed,  aiid  is  prolonged.  Such,  we  have  already  dis- 
covered, are  the  characteristics  of  the  action  of  centres  of 
the  higher  ranks. 

When  we  rise  once  more  to  actions  of  a  much  more  com- 
plicated character,  to  acts  such  as,  for  instance,  the  entering 
upon  a  lawsuit,  we  find  the  same  general  law  holds  good. 
It  is  the  impression  made  upon  the  organism  by  the  whole 
of  the  circumstances  of  the  case, — the  suffering  of  injury,  the 
refusal  of  redress,  the  ability  to  produce  witnesses,  the 
existence  of   documentary  evidence,  the  advice  of  trusted 


THE    NERVOUS   SYSTEM.  35 

counsellors, — that  starts  the  process  ;  which  in  this  case  is 
much  more  complicated,  much  more  delayed,  much  more 
prolonged,  but  which  is  still  at  every  step  guided  and 
modified  by  impressions  arriving  from  without. 

The  current  that  passes  upward  from  the  lower  centres 
has  been  spoken  of,  in  the  first  and  second  examples,  as  the 
remainder  of  the  ingoing  current  started  by  the  impression 
— the  remainder  that  is  left  over  after  the  reacting  centre 
has  been  started, — but  this  account  is  not  quite  complete. 
What  passes  upward  to  the  superior  centres  is  a  current 
compounded  of  the  ingoing  current  and  of  a  portion  of  the 
discharge  of  the  inferior  centre.  So  that  the  impression 
received  by  the  superior  centre,  in  the  first  case,  is  not  merely 
that  produced  by  a  body  approaching  the  eye,  but  also  that 
produced  by  a  discharge  of  the  centre  actuating  closure  of 
the  hds.  This  centre  therefore  discharges  in  two  directions. 
Its  downward  discharge  produces  a  closure  of  the  lids,  and 
the  remnant  of  the  discharge,  which  passes  upward,  acts  as  an 
ingoing  impressing  current,  and  conveys  to  the  superior 
centres  intelligence,  as  it  were,  that  the  lids  are  closing. 

Similarly,  every  discharge  of  an  inferior  motor  centre  is 
mirrored  in  the  superior  centres,  which  are  thus  rendered 
ate  fait  of  all  the  actions  of  their  subordinates. 

From  what  has  been  said  it  will  be  seen  that  the  organiza- 
tion of  the  nervous  system  is  an  intricate  arrangement  of 
centres,  disposed  in  layers  subordinate  to  each  other,  each 
layer  being  in  communication,  more  or  less  directly,  with  the 
sense  organs,  and  so  with  the  outside  world,  from  which  it 
receives  its  initiating  impulses  ;  and  each  being  in  communi- 
cation also  with  the  muscles,  to  which  it  issues  its  mandates. 

It  has  been  shown  how  a  centre  may  discharge  so  faintly 
that  the  resulting  current  has  not  sufficient  impetus  to  reach 
the  muscles,  but  although  the  discharge  produces  no  move- 
ment, it  is  not  without  effect.  It  spreads  where  it  can,  and 
produces  some  effect  on  neighbouring  centres.  It  may  be 
that  a  centre  is  discharged  by  an  ingoing  current,  but  that 
its  discharge  is  not  of   sufficient  moment   to  produce  an 


36  SANITY   AND   INSANITY. 

immediate  muscular  reaction.  Although,  however,  it  pro- 
duces no  effect  in  a  downward  direction,  it  may  pass  upward, 
and  on  reaching  the  higher  layer  it  may,  since  higher  centres 
are  more  unstable  than  lower,  produce  a  discharge  w^hich 
does  reach  the  muscles,  and  in  this  way  a  simple  impression 
may  bring  about  a  widespread  reaction.  It  is  to  be  noted, 
however,  that  the  current  which  starts  the  effectual  discharge 
is  derived,  not  from  the  simple  impression  alone,  but  from 
the  centre  first  discharged  by  this  simple  impression.  It  is 
a  much  more  complex  affair.  It  contains  elements  from  the 
ingoing  current,  and  elements  of  discharge  whose  usual 
destination  is  outwardly.  It  is,  to  speak  technically,  a 
a  sensori-motor  process.  The  lowermost  centre,  which  first 
receives  the  ingoing  current,  is  the  recipient,  not  of  this 
particular  impression  alone,  but  of  many  impressions  con- 
tinually arriving  from  the  same  special-sense  organ.  By 
these  continually  arriving  currents  its  constitution  and  the 
arrangement  of  its  elements  have  been  moulded  originally, 
and  modified  from  time  to  time.  Hence  the  discharge  that 
it  emits,  and  that  starts  the  action  of  the  superior  centre, 
while  initiated  by  the  particular  impression,  represents  not 
that  impression  only,  but  many  allied  impressions ;  and 
represents  not  impressions  only,  but  the  simple  movement  by 
which  these  simple  impressions  may  be  directly  responded 
to.  Thus  the  entire  leash  of  currents  that  starts  the  action 
of  the  superior  centre  is  a  very  complex  affair,  and  hence  it 
appears  that,  just  as  the  lower  centres  perform,  on  the  motor 
side,  as  it  were  the  menial  work  of  the  higher,  receiving 
their  mandates  in  general,  and  carrying  them  out  in  detail, 
with  the  aid  of  impressions  from  without  ;  so  on  the  ingoing 
or  sensory  side,  the  lower  centres  combine  and  elaborate  the 
impressions  received,  before  transmitting  them  to  the  higher. 
The  impressions  received  by  the  lowest  centres  of  all  are 
simple  currents  transmitted  direct  from  the  sense-organs  by 
which  they  are  received  ;  the  impressions  received  by  centres 
of  a  higher  rank  are  impressions  not  only  of  what  has  acted 
on  us  from  the  outside  world,  but  of  simple  ways  in  which 


THE    NERVOUS    SYSTEM.  37 

the  organism  can  react  on  the  outside  world.  Each  higher 
rank  of  centres  receives  impressions  from  below,  of  still  more 
complicated  and  intricate  nature. 

We  find,  therefore,  that  every  action  of  the  nervous  system, 
from  the  lowest  and  simplest  to  the  highest  and  most  com- 
plex, consists  of  four  parts — the  ingoing  current,  the  discharge, 
and  the  outgoing  current,  with  the  addendum  of  the  com- 
municating currents  between  the  centre  immediately  con- 
cerned and  its  superiors.  We  find  that  not  only  do  the 
centres  become,  in  proportion  to  their  position  in  the  scale 
of  elevation,  more  complicated  in  their  structure  and  more 
diverse  in  their  communications  with  neighbouring  centres, 
but  that  both  the  currents  they  emit  and  the  currents  they 
receive  become  continually  more  complicated  in  their 
composition. 

We  have  seen  that  in  that  part  of  the  nervous  system 
which  regiilates  the  molecular  processes  of  nutrition  the 
hierarchical  arrangement  prevails  with  quite  as  rigorous  a 
sway  as  in  that  which  regulates  the  molar  movements  of  the 
limbs  and  body  ;  we  have  now  to  notice  that  the  other 
principle — the  sensori-motor  principle,  or  the  principle  of 
flow  and  return  of  energy,  also  obtains  equally  throughout 
both  divisions  of  the  nervous  system. 

When  food  is  introduced  into  the  stomach,  the  local 
stimulus  produces  at  once  a  local  reaction,  and  the  lining  of 
the  stomach  pours  out  a  fluid  which  acts  upon  and  digests 
the  food.  This  immediate  reaction  is  analogous  to  the 
immediate  reaction  of  the  blink  of  the  eye  which  follows  a 
local  stimulus  to  the  other  system  of  nerves.  At  the  same 
time,  however,  the  contact  of  the  food  produces  a  discharge 
of  the  sensory  nerves  which  have  their  endings  in  the 
mucous  lining  of  the  stomach.  The  current  is  carried  by 
the  nerves  to  centres  of  low  rank,  which  discharge  downward 
into  the  muscular  wall  of  the  stomach  and  produce  move- 
ments by  v/hich  the  food  is  turned  over  and  churned  about. 
In  this  case,  therefore,  as  in  the  other,  there  is  (i)  an 
inward  current  started  by  a  stimulus  on  the  nerve  ends,  and 


38  SANITY   AND   INSANITY. 

going  to  a  nerve  centre  ;  (2)  a  discharge  of  the  centre ;  (3)  an 
outgoing  current  from  the  centre  to  muscles,  producing 
movement ;  and  there  is  also  (4)  a  residuum  of  current  passing 
from  the  centre  upward  to  a  higher  centre,  and  indicating  to 
the  higher  region  what  is  going  on  below.  To  the  higher 
centre  this  upward  current  acts  as  an  inward  or  stimulating 
current,  and  produces  therein  a  discharge  of  which  the 
main  part,  as  before,  goes  outward,  and  a  residuum  goes  to  a 
higher  centre  still.  The  reflexed  or  outgoing  part  of  the 
current  acts  as  a  relaxor  of  the  blood  vessels,  and  allows 
more  blood  to  go  to  the  stomach  to  supply  the  needs  of  the 
local  glands,  which  are  now  actively  at  work,  pouring  out 
their  digestive  juice  ;  part,  too,  goes  to  the  neighbouring 
portion  of  the  intestine,  which  gets  into  readiness  to  begin 
secreting  and  to  receive  and  deal  with  the  food  passed  on  from 
the  stomach.  Another  part  goes  to  the  liver  and  stimulates 
its  cells  into  activity. 

The  upward-going  portion  reaches  a  still  higher  centre, 
and  produces  effects  that  are  still  more  diffused  and  still  more 
indirect  to  the  original  stimulus  of  the  food  on  the  stomach. 

The  contact  of  food  with  the  stomach  is  of  course  not  the 
only  stimulus  which  provokes  this  upward-going  current. 
Not  only  does  contact  of  a  foreign  body  with  the  skin  set  up 
a  current  in  the  local  nerves  which  passes  upward  to  the 
highest  regions  of  the  brain,  but  the  soaking  of  a  solution  of 
food  material  through  the  mucous  membrane  of  the  mouth 
produces,  when  the  solution  comes  into  contact  with  the 
nerve-endings,  a  similar  current.  In  this  latter  case  the 
process  which  acts  upon  the  nerves  is  wholly  molecular. 
Similarly,  every  molecular  change  throughout  every  part  of 
the  body  gives  rise  to  an  alteration  of  the  nerve  currents, 
and  sends  an  alteration  up  through  the  series  of  nerve 
centres  to  the  highest.  The  nerve  currents  which  are 
originated  in  the  organs  of  sense  by  light  waves,  sound 
waves,  chemical  changes  in  the  mucous  membrane  of  tongue 
or  nose,  are  not  always  passing.  They  are  intermitted,  and 
arise  only   occasionally.     But    in    the    body   at   large,    the 


THE   NERVOUS   SYSTEM.  39 

processes  of  nutrition  and  decay,  of  waste  and  repair,  of 
secretion  and  elimination,  are  always  at  work,  and  hence  the 
currents  which  these  processes  originate  in  the  nerves  arc 
always  passing  upwards  to  the  brain.  As  the  processes  are 
always  at  work,  and  as  they  are  under  all  circumstances 
controlled  and  regulated  by  the  molecular  currents  which 
flow  into  them  through  the  nerves,  it  follows  that  not  only 
are  the  ingoing  currents  which  they  originate  always  passing, 
but  the  outgoing  currents  from  the  regulating  nerve  centres 
to  the  working  tissues  are  always  passing. 

Thus  there  is  in  the  body  a  double  circulation  of  nerve 
energy  just  as  there  is  a  double  circulation  of  blood.  From 
the  heart  to  the  body  at  large,  and  from  the  body  at  large 
back  to  the  heart,  flows  the  greater  or  systemic  circulation, 
and  from  the  heart  to  the  lungs,  and  from  the  lungs  back 
to  the  heart,  flows  the  minor  or  pulmonary  circulation. 
Similarly  from  the  sense  organs  and  the  skin  to  the  brain, 
and  from  the  brain  back  to  the  muscles,  flows  the  greater 
circulation  of  nerve  energy,  by  which  the  movements  of  the 
body  are  adapted  to  circumstances  in  the  outside  world  ; 
and  from  the  viscera  and  the  body  at  large  to  the  brain,  and 
from  the  brain  back  to  the  viscera  and  other  organs,  flows 
the  lesser  circulation,  by  which  activity  of  function  is  adapted 
to  bodily  needs. 

It  has  been  mentioned  above  that  the  higher  centres  are 
more  unstable  than  the  lower.  Their  equilibrium  is  more 
readily  disturbed,  their  discharge  more  readily  evoked,  their 
conmiunications  and  connections  more  readily  extended  and 
modified  than  those  of  the  lower.  It  remains  to  explain  this 
most  important  difference  in  their  mode  of  action. 

When  a  new  mode  of  action  is  originated — when  a  novel 
adjustment  is  made  to  circumstances — when  the  organism 
reacts  in  a  new  manner  to  impressions  made  upon  it,  there 
must  occur  some  new  combination  of  nerve  elements  to 
produce  the  new  combination  of  movements.  The  new 
combination  of  nerve  elements  is  affected  in  the  way  already 


40  SANITY   AND   INSANITY. 

indicated  when  treating  of  the  matrix  or  ground  substance 
of  the  grey  matter.  Either  a  new  set  of  circumstances 
impresses  the  organism,  in  which  case  a  new  combination  of 
nerve  currents  sets  inward  ;  or  an  old  set  of  circumstances 
impresses  the  organism,  in  a  new  way,  in  which  case  the  old 
combination  of  nerve  currents  receives  a  new  addition  on  its 
way  upward,  which  alters  its  arrangement  and  direction. 
In  either  case,  the  higher  centres  are  impressed  in  a  way  that 
is  new,  and  the  consequence  is,  that  instead  of  the  usual 
centres  being  discharged  in  the  usual  ways,  the  currents  are 
drafted  off  into  new  directions.  But  it  has  already  been 
shown  that  the  channels  in  which  currents  frequently  pass, 
are  channels  which  have  become,  from  the  effect  of  this 
frequent  passage,  scoured  out  to  an  appropriate  calibre,  and 
able  rto  carry  the  accustomed  currents  without  leakage  ; 
while  the  irruption  of  a  voluminous  current  into  by-paths 
and  unaccustomed  channels  results  in  its  escape  from  the 
formed  channels  into  the  ground  substance,  and  the  excava- 
tion of  new  passages  therein.  When,  therefore,  new 
circumstances  impress  us,  or  when  old  circumstances  impress 
us  in  new  ways,  there  is  a  tendency  for  the  nerve  currents  in 
the  higher  centres  to  break  their  bounds  and  to  escape  in 
new  directions.  Whether  the  tendency  becomes  an  actuality 
or  no,  will  depend  on  whether  the  new  element  in  the 
incoming  current  is  of  sufficient  intensity,  and  whether  the 
ground  substance  is  easily  enough  permeable.  Supposing, 
however,  that  these  conditions  are  favourable,  and  that  the 
current  does  overflow,  it  will  find  its  way,  in  some  new 
direction,  to  a  centre  that  has  not  hitherto  been  in  the  habit 
of  acting  with  the  centre  from  whence  the  discharge  comes. 
(For,  if  it  had  habitually  so  acted,  a  formed  channel  would 
already  exist  between  them.)  The  consequence  will  be  that 
these  two  centres,  not  hitherto  associated  in  action,  will  act 
together — in  other  words,  a  new  combination  of  nerve 
centres  will  be  formed,  and  their  combined  action  will 
result  in  a  new  mode  of  reaction — in  new  movements,  or  a 
new  course  of  conduct. 


THE   NERVOUS   SYSTEM.  4 1 

The  repetition  of  the  impression  will  bring  about  a 
repetition  of  the  action,  and  Avith  each  such  repetition  of  the 
passage  of  the  current  in  the  new  direction,  the  new 
channel,  which  conveys  the  current  from  one  centre  to  the 
other,  will  be  enlarged,  and  rendered  more  patent  and 
definite,  in  the  way  already  described  ;  until  the 
connection  between  the  two  centres  becomes  thoroughly 
organized,  and  the  course  of  action  habitual.  The  more  and 
more  often  the  combined  action  is  repeated,  the  more 
thorough  and  complete  becomes  the  union  between  the  two 
centres,  and  the  less  and  less  readily  does  the  combination 
of  their  action  admit  of  interference  from  centres  outside  of 
them.  By  the  mere  force  of  repetition  and  of  the  definite 
organization  which  repetition  brings  about,  novel  acts 
become  habitual  ;  habitual  acts  become  automatic  ;  and 
automatic  acts  become  reflex.  The  differences  between 
these  several  degrees  of  consolidation  are  thus  marked.  An 
act  is  habitual  when  it  occurs  with  perfect  facility,  but  yet 
requires  the  guidance  and  direction  of  higher  centres  for  its 
performance.  An  act  is  automatic  when  it  has  become  so 
far  organized  that  the  mechanism  which  actuates  it  is 
complete  in  itself,  and,  given  the  necessary  impression,  the 
action  occurs  without  any  guidance  or  regulation  from 
higher  centres.  Such  are  the  acts  of  walking,  the  fingering  of 
musical  instruments,  the  manipulation  in  many  handicrafts, 
the  movement  of  the  lips  and  tongue  in  speaking.  All  these 
movements  occur  with  a  celerity  and  an  accuracy  which 
indicates  thorough  organization  ;  all  of  them  can  be 
performed  without  direct  guidance  from  the  higher  centres, 
or  while  the  higher  centres  are  otherwise  employed — while, 
as  we  say,  we  are  "  thinking  of  something  else  "  ;  and  any 
direct  interference  of  the  higher  centres — any  undue  atten- 
tion to  the  movem.ents  tends  to  spoil  their  facility  and 
accuracy.  Lastly,  when  organization  is  complete,  move- 
ments become  reflex  ;  that  is  to  say,  not  only  do  they  occur 
on  the  occurrence  of  their  appropriate  stimulus,  but  they 
occur    necessarily.     The    nerve-channel    is    so    completely 


42  SANITY   AND   INSANITY. 

formed  in  itself,  and  the  neighbouring  currents  are  so  built  out, 
that  when  once  the  process  is  started,  it  goes  on  to  completion 
as  a  matter  of  necessity,  and  no  action  of  the  higher  centres 
can  interfere  to  prevent  or  alter  it.  Such  movements  are 
those  of  blinking,  of  swallowing,  of  coughing,  and  the  like. 

Several  implications  and  consequences  of  this  property  of 
mere  repetition  to  bring  about  the  organization  of  a  nervous 
process  demand  our  notice. 

It  has  been  seen  how,  as  the  channel  between  the  newly- 
connected  centres  becomes  more  permeable,  the  ease  with 
which  they  act  together  is  increased.  Thus  repetition 
produces  facility  of  action.  How  true  this  is,  the  whole 
experience  of  education  teaches  us. 

It  has  also  been  seen  that,  as  the  channel  becomes  wider  and 
more  permeable,  there  is  less  lateral  diffusion  of  the  current. 
The  new  channel  becomes  by  degrees  able  to  take  up  and 
transmit  the  whole  of  the  current,  and  those  portions  which 
at  first  spread  here  and  there,  and  aroused  the  activity  of 
neighbouring  centres,  are  absorbed.  The  effect  of  these 
wandering  currents  was  to  produce,  along  with  the  new 
combination  of  movements,  a  number  of  superfluous  move- 
ments, such  as  those  of  the  tongue  and  face  that  we  see  in 
children  learning  to  write  ;  such  as  are  seen  in  the  straggling, 
disordered,  and  excessive  movements  exhibited  by  the  novice 
in  playing  tennis,  in  fencing,  skating,  and  in  every  other 
complicated  exercise.  As  efficiency  increases  by  practice, 
these  superfluous  movements  disappear,  and  in  nothing  does 
the  play  of  the  expert  appear  more  remarkable  than  in  the 
slight  apparent  exertion  with  which  he  attains  success. 

The  effect  of  repetition  in  producing  a  fixed  organization, 
and  so  shutting  off  partly  or  entirely  the  influence  of  superior 
centres,  has  already  been  referred  to  ;  but  it  is  obvious  that 
this  effect  will  only  be  produced  when  the  action  is  at  each 
repetition  free  from  such  interference.  If  at  each  repetition 
the  action  is  modified,  then  will  the  tendency  to  modification 
become  organized  along  with  the  rest  of  the  mechanism,  and 
the  result  will  be  an  arrangement  like  that  which  actuates 


THE   NERVOUS   SYSTEM.  43 

the  movements  of  walking,  for  instance,  in  which  the  stage 
of  automatism  has  been  reached,  not  only  b)^  the  fundamental 
to  and  fro  movements  of  the  legs,  but  also  by  the  various 
modifications  rendered  necessary  by  inequalities  in  the 
ground,  obstacles,  hills,  turnings,  and  so  forth. 

Hitherto,  for  the  sake  of  simplicity,  the  new  channel  be- 
tween the  two  centres  has  been  spoken  of  as  a  single  channel, 
but  this  of  course  is  far  from  being  the  case.  It  is  a  compli- 
cated leash  of  channels.  And  the  communication  spoken  of 
as  established  between  two  centres,  is  actually  made  between 
many.  To  go  back  to  our  account  of  the  way  in  which  the 
communication  is  first  established.  A  leash  of  incroincr  cur- 
rents  disposed  in  a  novel  arrangement  disturbs  a  centre,  or 
group  of  centres,  in  a  new  way,  and  produces  a  discharge  in 
a  new  direction.  The  discharge  thus  started  travels  in  a  com- 
plicated mesh  of  channels,  which  are,  ex  hypothesis  unaccus- 
tomed to  carry  a  discharge  of  this  volume.  The  discharge, 
therefore,  escapes  into  the  ground  substance,  and  forms  new 
connections  in  the  way  already  described.  Having  got  a 
clear  idea  of  the  process  in  its  simplest  form,  we  may  now  go 
on  to  note  that  the  escape  of  the  discharge  into  the  ground 
substance  will  take  place  not  at  one  point  only,  but  at  many  ; 
and  the  communication  opened  up  will  be  with  not  one 
centre  only,  but  with  several.  The  general  result  will  be,  in 
short,  that  after  proceeding  for  a  certain  distance  in  estab- 
lished channels,  the  discharge  will  break  out  in  several 
directions  and  form  new  communications  with  several 
centres.  The  point  at  which  the  discharge  breaks  out  will 
therefore  become  the  point  of  meeting  of  several  complex 
groups  of  channels,  converging  from  several  directions.  In 
the  course  of  the  general  activity  of  the  nervous  system, 
discharges  will  frequently  pass  along  one  or  another  of  these 
channels,  and  often  along  more  than  one  at  a  time,  towards 
the  point  of  meeting.  But  when  two  currents  passing  along 
the  same  fibre  in  opposite  directions,  meet,  the  point  of  meet- 
ing tends  to  become  an  enlargement — to  grow  into  a  cell. 
And  where,  as  in   this  case,  many  fibres  meet  in  a  plexus 


44  SANITY   AND   INSANITY. 

within  a  given  area,  there  will  be  many  points  of  meeting 
of  opposing  currents — there  will  ensue  a  formation  of  many- 
cells.  The  point,  or  rather  the  area,  of  the  meeting  of  these 
various  groups  of  channels  will,  in  short,  develop  into  a 
nerve  centre. 

Now  notice  the  connections  of  this  new  centre,  thus 
formed.  It  is  a  meeting-place  for  the  channels  of  egress  of 
several  centres,  each  of  these  channels  having  a  complexity 
of  composition  representing  that  of  the  centre  from  which 
it  issues.  The  meeting  of  these  channels,  of  such  a  com- 
plexity, produces  a  mesh  of  much  greater  complexity — of 
complexity,  roughly  speaking,  equal  to  the  sum  of  the  com- 
plexities of  the  components.  This  mesh  becomes  in  course 
of  time  a  centre,  and,  as  a  centre,  retains  nearly  all  its 
original  complexity.  So  that  the  new  centre  is  far  more 
complex  in  composition  than  any  of  the  old  ones. 

When  the  new  centre  discharges,  the  discharge,  carried 
simultaneously  by  all  the  contributing  channels  to  all  the 
contributing  centres,  will  arouse  the  activity  of  all  these 
centres  ;  and  hence,  whatever  activities  the  contributing 
centres  represented,  the  new  centre  will  represent  them  all. 
If  each  of  the  contributing  centres  represented  activity  of  a 
part  of  the  body,  the  new  centre  will  represent  activity  of  all 
these  parts.  If  the  contributing  centres  represented  various 
modes  of  activity  of  the  whole  body,  the  new  centre  will 
represent  all  these  modes. 

The  connections  of  the  new  centre  being  with  the  con- 
tributing centres  only,  any  influence  it  may  have  on  the 
muscles  can  be  exerted  only  through  the  contributing  centres. 
Its  connection  with  the  muscles  is  therefore  less  direct  or 
immediate  than  theirs. 

In  every  respect  the  new  centre,  as  compared  with  the  old 
or  contributing  centres,  has  the  qualities  which  have  already 
been  described  as  characteristic  of  higher  centres,  and  hence 
we  arrive  at  the  general  conclusions,  that  the  higher  centres 
are  of  more  recent  formation  than  the  lower,  and  that  as 
the  experiences  of  life  accumulate,   as   new  circumstances 


THE   NERVOUS   SYSTEM.  45 

from  time  to  time  impress  the  organism,  and  as  old  circum- 
stances impress  the  organism  in  new  ways,  new  strata  of 
nerve  centres  are  continually  being  laid  down  on  the  top  of 
the  old.  The  entire  nervous  system  is  continually  breaking 
out  on  its  upper  surface  into  growths  of  greater  and  greater 
complexity  and  elaborateness.  Each  outgrowth  is  no  sooner 
completed  than  it  is  dominated  by  a  still  loftier  growth. 
Each  stratum  is  no  sooner  laid  down  than  it  is  submerged 
beneath  one  still  more  recent. 

We  have  seen  how  little  a  channel  that  is  in  course  of 
formation  differs  from  the  matrix  out  of  which  it  is  formed. 
And  we  have  seen  how  little  a  nerve-cell  that  is  swelling  in 
the  course  of  a  fibre  is  distinguished  from  the  matrix 
from  which  it  is  separated.  It  is  obvious  that,  at  their 
early  stages,  it  will  take  but  a  slight  disturbing  influence 
to  derange  the  formative  process  that  is  going  on  ;  and  that 
a  disturbance  that  would  have  no  appreciable  effect  on  the 
fully  formed  fibre  protected  by  its  insulating  jacket,  or  on  the 
mature  cell  fixed  in  its  organization,  might  altogether  destroy 
the  slight  difference  existing  between  the  nascent  fibre  or 
cell,  and  the  ground  substance  from  which  it  was  becoming 
differentiated.  It  will  be  obvious,  too,  that  disturbing 
agencies  acting  on  nerve  centres  will  produce  effects  of 
magnitude  inversely  proportional  to  the  age  of  the  centre. 
The  youngest  centres,  which,  as  we  have  seen,  are  also  the 
most  complex  and  the  most  elaborate,  and  the  highest  in 
every  sense,  will  be  the  first  to  be  affected  by  the  disturbance. 
As  the  disturbance  increases,  they  will  be  more  and  more 
deranged,  and  at  the  same  time  the  derangement  will  spread 
deeper  and  deeper,  to  centres  that  are  older  and  more  fully 
fixed  in  organization.  The  highest  centres  will  be  affected 
first  and  most,  the  lowest  last  and  least,  the  intermediate 
centres  intermediately. 

If  we  notice  the  effect  of  a  late  frost  upon  the  vegetation 
of  the  garden,  we  see  that  it  is  the  youngest  shoots  and  the 
newly  opening  leaves  that  are  most  severely  affected — that 
are    blackened   and    shrivelled    by    its    effects.      The    old 


46  SANITY   AND    INSANITY. 

leaves,  whose  fibres  have  become  fully  developed,  and  whose 
structure  is  fully  organized  and  fixed  are  not  injured. 
Should  the  frost  be  more  severe,  we  shall  find  that  not  only 
are  the  young  leaves  killed,  but  the  old  ones  also  suffer  more 
or  less  severely.  The  woody  trunks,  however,  are  uninjured, 
for  in  a  week  or  two  they  begin  again  to  push  out  their  buds 
and  show  their  unimpaired  vitality.  Should  the  frost  be  of 
extreme  severity,  the  whole  tree  may  perish.  Now  notice 
that,  say  in  the  case  of  the  peach,  the  flowers,  the  parts  that 
are  earliest  attacked  and  soonest  succumb  to  the  slightest 
adverse  influence,  are  the  most  highly  elaborate  part  of  the 
tree,  and  fulfil  the  most  complex  and  far-reaching  function. 
The  leaves,  which  are  the  next  to  suffer,  are  the  next  in 
elaborateness  of  organization,^  and  next  in  the  complexity 
and  general  elevation  of  the  functions  that  they  fulfil,  while 
the  last  part  of  the  tree  to  suffer  is  the  wood,  which  is  not 
only  the  oldest  and  the  most  fixedly  organized,  but  subserves 
also  the  simplest  and  most  fundamental  functions. 

*  Flowers  and  leaves  are  not  commonly  seen  on  the  peach  at  the  same 
time,  but  the  simile  is  sufficiently  accurate  for  the  present  purpose. 


CHAPTER  III. 


THE    MIND. 


So  far  we  have  considered  the  hving  organism  as  a  mechan- 
ism, accumulating  energy  and  expending  it  in  movement  ; 
receiving  impressions  from  the  outside  world,  and  responding 
to  them  by  adapted  actions  :  but  we  have  not  yet  dealt  with 
the  phenomena  of  mind,  nor  have  we  found  how  mental 
phenomena  are  related  to  the  working  of  this  elaborate 
nervous  mechanism. 

The  relation  of  mind  to  nervous  processes  is  very  peculiar, 
and  since  it  is,  in  fact,  very  different  from  that  which  is 
vaguely  current,  and,  I  will  not  say  accepted,  but  assumed, 
by  many  who  have  not  studied  the  matter,  it  will  be  neces- 
sary for  the  reader  to  rid  himself  as  far  as  possible  of  all  the 
preconceived  notions  of  the  matter,  and  to  begin  its  con- 
sideration afresh  with  a  perfectly  open  mind. 

In  the  first  place,  he  must  discard  altogether  the  notion 
that  mind  can  work  upon,  or  influence,  or  produce  changes 
in,  the  nervous  system,  or  in  matter  of  any  kind,  however 
arranged  ;  and,  in  the  second  place,  he  must  rid  himself  of  the 
idea  that  any  nervous  process,  or  any  movement,  or  re- 
arrangement of  material  particles,  can  ever,  under  any  cir- 
cumstances, be  transformed  into  a  mental  phenomenon — into 
an  idea,  or  a  feeling,  or  any  other  state  or  condition  of  mind. 
That  such  transference  of  the  mental  into  the  material  is 
possible,  and  even,  that  it  is  usual  and  normal,  is  an  assump- 
tion made  not  only  daily  and  hourly  by  the  laity  in  ordinary 
conversation,  but  also  with  intolerable  frequence  by  writers 
on  psychology  who  ought  to  know  better.     We  find  their 


48  SANITY   AND   INSANITY. 

works  peppered  all  over  with  terms  that  imply  that  the  states 
and  movements  of  matter  are  convertible  into  states  and 
processes  of  mind.  One  writer  speaks  of  memories  being 
stored  up  in  the  brain-cells.  Another  explains  how  an  ingoing 
current  undergoes  a  "  peculiar  metabolic  "  change,  becomes 
"  animalized,  intellectualized,"  and  finally  is  transformed  into 
an  idea  ;  which  is  much  as  if  a  beefsteak  were  put  into  a 
sausage-machine,  where  it  would  undergo  a  peculiar  meta- 
bolic change,  and  emerge  as  a  sonata.  One  eminent  writer 
sus:oests  that  the  brain  contains  a  substance  intermediate 
between  mind  and  matter,  which  partakes  of  the  nature  of 
both  without  being  exclusively  either.  Imagine  a  thing 
which  is  partly  an  iron  bar  and  partly  a  smell  of  paint, 
without  being  exclusively  either  !  It  is  frequent  to  find 
the  mind  spoken  of  as  a  form  of  brain-energy.  One  person 
who  writes  on  psychology  says  that  the  brain  secretes  ideas 
as  the  liver  secretes  bile.  Such  terms  and  phrases  as  "  psycho- 
motor centres,"  "ideo-mctor  processes,"  "sensations  changing 
into  movements,"  are  exceedingly  common  ;  while  com- 
monest and  worst  of  all  is  the  prevalent  opinion,  expressed 
or  implied,  that  above  the  material  part  of  the  brain,  some- 
where in  the  skull  cavity,  there  sits  a  little  deity  who  sends 
his  orders  out  this  way  and  that,  and  by  some  mysterious  but 
easy  process  produces  all  the  movements  of  the  body.  He 
plays  on  the  centres  of  the  brain  as  a  performer  plays  on 
the  key-board  of  the  piano,  and  produces  just  such  combina- 
tions and  successions  of  movements  as  he  pleases,  untram- 
melled by  natural  laws.  This  being  is  variously  named, 
according  to  the  predilections  of  the  writer,  some  calling  him 
the  Will,  others  the  Ego,  others  again  the  Conscious  Per- 
sonality, others  the  Soul  ;  while  yet  others  split  him  up  into 
several  beings,  and  with  the  natural  tendency  of  anthropo- 
morphism, not  only  let  them  make  common  cause  against 
their  unfortunate  servant,  the  body,  but  set  them  fighting 
among  themselves.  The  whole  doctrine  is  a  survival  in 
slightly  altered  form  of  the  old  superstition  of  demoniacal 
possession. 


THE   MIND.  49 

It  is  very  obvious  that  if  the  brain  is  made  up,  as  we  know 
it  to  be,  entirely  of  cells,  fibres,  and  ground  substance,  with 
the  necessary  framework  of  connective  tissue,  blood  vessels, 
and  so  forth  ;  and  if  the  processes  going  on  in  this  structure 
are  limited,  as  we  know  them  to  be,  to  molar  and  molecular 
movements  ;  there  is  neither  room,  nor  need,  nor  possibility 
for  any  interference  of  mental  conditions  with  these  move- 
ments of  material  particles.  Reduce  the  affair  to  its  simplest 
expression,  and  see  how  it  looks,  not  when  spoken  of  vaguely 
in  general  terms,  but  when  closely  examined  and  brought  to 
a  focus. 

You  come  in  from  a  walk  on  a  hot  summer  day  feeling  very 
thirsty.  You  see  a  glass  of  water  on  the  table  and  you  drink 
it.  To  what  were  due  those  movements  of  stretching  out 
the  hand,  grasping  the  tumbler,  and  lifting  it  to  the  mouth  ? 
To  thQfeelmgoi  thirst,  you  say,  and  to  the  desire  for  water 
to  quench  it.  Well,  the  actual  movement  we  have  seen  to 
be  actuated  by  the  discharge  of  a  nerve  centre,  under  the 
guidance  of  impressions  arising  from  without,  that  is  to  say, 
of  nerve-currents  running  inward  from  the  eyes,  and  upon 
the  initiation  of  a  discharge  descending  from  higher  centres. 
Now,  at  what  point  in  this  series  of  processes  does  the  influ- 
ence of  the  feeling  or  the  desire  come  in  ?  Does  it  alter  the 
discharge  of  the  nerve-centre,  or  does  it  bring  this  discharge 
about  ?  We  know  what  the  discharge  is.  It  is  a  liberation  of 
energy  due  to  a  rearrangement  of  molecules — due  to  the 
falling  of  the  molecules  into  simpler  combinations.  Take 
a  feeling  of  thirst  and  drive  it  against  the  molecules  so  as  to 
upset  their  equilibrium  ;  or  take  a  desire  for  water  and  knock 
it  against  the  nerve  centre.  You  cannot.  Can  you  inter- 
pose a  feeling  of  thirst,  or  a  desire  for  water,  in  the  course 
either  of  the  current  running  from  the  eye  to  the  centre,  or 
of  the  current  running  from  the  centre  to  the  muscles  ? 
These  currents,  as  we  call  them,  are,  as  we  know,  merely  a  suc- 
cession of  changes  communicated  from  molecule  to  molecule. 
Take  a  feeling  of  thirst  and  push  it  between  two  molecules. 
You  cannot.    But,  you  will  say,  these  are  not  stages  at  which 

5 


50  SANITY   AND   INSAXITV. 

the  mental  process  comes  in.  There  is  a  fourth  element. 
There  is  the  current  descending  from  the  higher  centre 
which  initiates  the  action  of  the  centre  actuating  the  move- 
ment of  reaching  for  and  grasping  the  glass.  The  feeling  of 
thirst,  the  desire  for  water,  precedes  the  movement.  It  is  in 
these  higher  centres  whose  action  also  precedes  the  move- 
ment, that  the  feelings  produce  their  effects.  Well,  mount 
as  high  as  you  like,  whatever  part  of  the  brain  you  explore, 
you  will  find  nothing  but  cells,  fibres,  and  ground  substance, 
and  all  alike  are  reducible  to  molecules — to  molecules 
differently  arranged  and  moving  in  different  ways.  Take  any 
one  of  these  molecules,  or  any  combination  of  them,  that  you 
please.  Twist  them  and  turn  them  about  as  you  like,  com- 
bine them  into  what  groups  of  utmost  complexity  you  can 
conceive,  when  all  is  done,  have  you  produced  anything  that 
has  the  appearance  of  a  feeling  of  thirst,  or  of  a  desire  for 
water  ?  Or  notice  their  movements,  and  say  whether  there 
is  anything  in  them  that  resembles  feeling — not  that  appears 
to  be  prompted  by  feeling,  but  that  itself  resembles  thirst  or 
desire.  If  there  be  no  such  movement,  then  create  one, 
imagine  one,  attempt  to  conceive  some  molecular  movement 
which  shall  resemble  a  feeling,  a  desire,  or  an  idea.  The 
thing  is  impossible.  It  is  not  merely  impossible — that  is  a 
feeble  term  to  express  our  impotence — it  is  inconceivable. 
Not  only  is  it  not  now  possible,  but  it  is  manifest  that  under 
no  circumstances,  after  no  lapse  of  time,  by  no  future  exten- 
sion of  our  knowledge  or  of  our  intelligence,  will  such  a  thing 
ever  become  possible.  The  movements  of  matter  and  the 
phenomena  of  mind  are  separated  by  a  fathomless  abyss. 
Betwixt  the  one  and  the  other  there  is  a  great  gulf  fixed,  and 
neither  can  matter  act  upon  or  induce  changes  in  mind,  nor 
can  mind  act  on  or  induce  changes  in  matter. 

At  this  point  I  shall  probably  find  myself  bereft  of  my 
reader's  sympathy  and  concurrence.  "  What  !  "  he  will  say, 
"  mind  not  act  upon  matter  !  How  is  it  then  that  I  lift  my 
hand  to  my  head  when  I  will  to  do  so  ?  how  is  it  that  a 
sudden  fright  makes  me  turn   pale  ?  how  docs  anxiety  dry 


THE    MIND.  51 

my  mouth  ?  why  does  an  amusing  thought  cause  laughter  ? 
how  is  it  that  faith  undoubtedly  cures  bodily  diseases  ? 
whence  is  the  tendency  for  every  thought  to  translate  itself 
into  action  ?  whence  the  outward  expression  of  every  emo- 
tion ?  The  whole  daily  and  hourly  experience  of  life  is  dead 
against  your  first  statement  ;  and  as  to  matter  not  acting 
upon  mind,  if  I  am  struck  do  I  not  feel  pain  ;  if  I  lose  blood 
do  I  not  feel  dizzy  ;  if  I  drink  enough  brandy  do  I  not  lose 
my  senses  ;  if  I  take  opium  do  I  not  fall  asleep  ?  The  whole 
proposition  is  monstrous." 

Well,  so  it  seems  at  first  blush,  but  a  complete  explanation 
is  contained  in  the  difference  between  the  words  post  and 
propter.  It  is  not  denied  that  the  events  occur  in  the  order 
stated,  but  the  inference  drawn  from  their  succession  is  not 
the  same. 

The  true  connection  between  nervous  and  mental  pheno- 
mena is  believed  to  be  this  :  that  when,  in  the  course  of  its 
circuit  which  we  have  so  often  traced,  from  the  organs  of 
sense  to  the  muscles,  a  nerve  current  reaches  the  highest 
centres,  and  sets  them  in  action,  then  this  activity  of  the 
highest  nervous  centres  is  attended,  we  cannot  say  why  or 
how,  by  a  mental  state.     Every  alteration  of  nervous  tension   /T-/    • 
in  these  upper  centres  is  attended  by  a  variation  in  the      ^J- — 
mental  procosses.     Every  fluctuation   of  nerve  currents  in      ^'^^^^ 
this  way  and  in  that,  has  an  accompaniment  in  a  variation  of 
mental  states  strictly  in  correspondence  with  it.     The  one 
set  of  changes  takes  place  in  the  nervous  system,  and  is  an 
affair  of  molecules  and  discharges  and  nerve  currents.     The 
other  set  of  changes  takes  place  in  the  mind,  and  is  an  affair 
of  ideas  and  feelings  and  volitions.     The  one  set  of  changes 
accompanies  the  other  set  of  changes  invariably  and  instantly, 
just  as  the  movements  of  the  shadow  accompany  the  move-   6^*tAt 
ments  of  the  man.     But  the  mental  changes  can  no  more      P^fX^ 
influence  or  alter  the  nervous  changes,  than  the  shadow  can    ^""^^ 
move  the  man  ;  and  the  nervous  system,  or  the  body  w^hich 
contains  it,   can    no    more  act    independently  and   directly 
upon  the  mind  than  the  man  can  pick  up  his  shadow  and. 


52  SANITY   AND    INSANITY. 

throw  it  away.  The  influence  of  the  body  is  limited  to  the 
changes  that  it  brings  about  in  the  working  of  the  higher 
nervous  centres  ;  and  when  such  a  change  is  produced,  a 
change  of  mental  processes  takes  place  simultaneously,  just 
as  a  change  of  attitude  of  the  body  is  accompanied  by  a 
change  of  shape  of  the  shadow.  But  to  suppose  that  an 
action  on  the  body  can  influence  the  mind  without  changing 
the  nervous  centres,  is  like  supposing  that  a  man  can  alter 
the  shape  of  his  shadow  without  moving  his  body. 

As  on  the  sensory  or  ingoing  side,  so  on  the  motor  or  out- 
going side  ;  the  mental  state  does  not  arise  save  only  when 
the  nervous  process  is  set  a-going.  When  a  certain  nerve- 
centre  discharges,  it  stimulates  certain  muscles  in  such  a  way 
as  to  produce  a  movement  of  the  arm.  That  is  the  bodily 
process.  Simultaneously  with  this  discharge  of  the  nerve 
centre,  and  with  this  movement  of  the  arm,  an  idea  of 
moving  the  arm  arises  in  the  mind.  The  shadow  of  the 
bodily  movement  is  thrown  upon  the  screen  of  the  mind, 
and  we  know  that  we  are  moving.  The  idea  of  the  move- 
ment is  not  in  the  centre  ;  it  is  not  in  the  cells  ;  nor  in  the 
fibres.  It  is  not  entangled  in  any  material  process  ;  nor  does 
it  exist  in  any  place.  When  the  centre  energizes,  the  idea 
arises,  and  that  is  all  we  know.  It  may  happen,  and  this  is 
most  important,  that  the  discharge  of  the  centre  is  not  suf- 
ficiently powerful  to  reach  the  muscles,  and  that  consequently 
no  actual  movement  occurs  ;  but,  nevertheless,  if  the  dis- 
charge takes  place,  its  mental  shadow  is  formed,  and  still  we 
have  an  idea  of  the  movement,  though  no  movement  take 
place.  When  the  discharge  is  powerful  and  the  movement 
actual,  the  mental  shadow  is  vivid,  and  the  mental  state  is 
that  of  willing  the  movement  and  oi  feeling  that  we  are 
moving.  When  the  discharge  is  faint  and  the  movement 
does  not  occur,  the  mental  shadow  is  a  mere  penumbra  ;  the 
mental  state  is  that,  not  of  willing  the  movement,  but  of 
thinking  of  the  movement. 

A  German  physiologist  has  said  that  there  is  no  thought 
without   phosphorus.      He  might   as  well   have   said   that 


THE    MIND.  53 

there  is  no  thought  without  carbon,  no  thought  without 
oxygen,  without  nitrogen,  or  without  any  one  of  the 
numerous  elements  which  enter  into  the  molecular  constitu- 
tion of  the  nervous  system.  The  complete  expression  is  that 
there  is,  no  thought^  or  rather  no  mental  condition,  withotit  a 
nervous  process.  There  is  no  mental  condition — no  thought, 
and  no  feeling — which  is  not  the  mental  shadow,  or  equiva- 
lent, or  obverse,  or  accompaniment,  of  some  process,  some 
discharge,  some  disturbance  of  tension,  or  some  molecular 
rearrano-ement  in  the  nervous  centres. 

This  is  the  secret  of  the  connection  between  body  and 
mind.  When  a  violent  impression  is  made  upon  the  body, 
when  the  body  is  struck,  or  pinched,  or  cut,  or  torn,  a  current 
of  great  intensity  rushes  to  the  highest  nervous  centres,  and 
produces  in  them  a  violent  commotion.  This  violent  mole- 
cular commotion  in  the  highest  nervous  centres  has  its 
mental  counterpart  in  a  violent  commotion  of  the  mind, 
which  we  call  pain.  When  brandy  or  opium  is  absorbed  from 
the  stomach  into  the  blood,  and  poured  by  the  blood  upon  the 
highest  nervous  centres,  it  benumbs  their  action,  it  stills  the 
vibrations  of  the  molecules,  it  clogs  the  groups  of  molecules 
into  clusters  of  inert  particles.  Molecules  so  poisoned  can 
no  longer  fulfil  their  functions  ;  they  are  unable  to  transmit 
discharges.  Their  forces  are  locked  up  and  unable  to  escape. 
The  busy  commotion  of  the  centres  subsides  into  stillness. 
The  centres  no  longer  discharge.  Since  there  is  no  dis- 
charge, there  can  be  no  mental  accompaniment,  and  con- 
sequently states  of  mind  cease  to  exist.  As  the  stillness 
settles  down  on  the  molecular  activity  of  the  centres,  so, 
simultaneously,  consciousness  fades  into  unconsciousness. 

On  the  motor  side  the  difficulty  will  be  greater  of  persuad- 
ing the  reader  that  his  oldest  and  most  cherished  notions  of 
bodily  activity  are  mistaken.  If  there  is  anything  certain  in 
life,  it  would  appear  to  be  that  w^e  move  our  limbs  and  speak 
our  thoughts  by  an  effort  of  will  ;  and  that  in  this  case, 
undoubtedly,  the  mental  process  is  not  only  the  forerunner, 
but  the  actual  cause  of  the  bodily  movement.     It  is  not  so 


54  SANITY    AND    INSANITY. 

however.  The  high  pressure  and  constant  widespread 
activity  of  our  highest  centres,  during  our  waking  hours, 
have  for  their  mental  image  a  complex  state  of  consciousness, 
which  is,  for  the  time  being,  our  conscious  or  mental  self. 
So  long  as  this  activity  is  equally  and  widely  diffused,  and  is 
everywhere  of  moderate  intensity,  so  long  we  are  wakeful, 
but  bodily  inactive.  Let,  however,  a  concentration  of 
energy  take  place  in  any  particular  region,  so  that  this 
region  is  aroused  into  preponderant  activity,  and  imme- 
diately the  bodily  movement  actuated  by  that  region  begins. 
Now,  since  every  molecular  change  in  these  superior  nervous 
regions  has  its  own  special  and  characteristic  mental  shadow, 
it  will  easily  be  imagined  that  so  marked  and  conspicuous 
and  important  a  process,  as  the  concentration  of  energy  in  a 
limited  area,  will  have  a  similarly  marked  and  conspicuous 
and  important  mental  accompaniment.  The  particular  con- 
dition of  mind  that  accompanies  this  process  is  termed 
Willing ;  and  the  exercise  of  will,  which  appears  to  be  the 
cause  of  bodily  movements,  is  in  reality  the  mental  shadow 
of  the  particular  nervous  process  which  really  is  the  cause. 

It  has  been  said  that  mental  phenomena  accompany  the 
action  of  the  higher  centres  only,  and  it  remains  to  explain 
this  peculiar  difference  between  the  higher  centres  and  the 
lower.     Let  us  first,  however,  establish  the  fact. 

It  has  been  shown  how  the  occurrence  of  a  new  mode  of 
action  means  the  establishment  of  a  new  centre,  and  how 
the  newest  centres  are  always  added  on  the  surface  while  the 
oldest  are  also  the  lowest.  When  a  new  mode  of  action  is 
initiated,  when  a  thing  is  done  for  the  first  time,  when  we 
first  begin  to  learn  a  new  accomplishment,  a  new  poem,  a 
new  handicraft,  the  process  is  not  only  slower  and  more 
difficult  than  on  subsequent  repetition,  but  it  is  also  attended 
by  a  more  vivid  consciousness.  It  requires,  as  we  say,  a 
greater  mental  effort.  It  lias  a  much  more  conspicuous 
mental  accompaniment.  With  each  repetition,  the  action 
not  only  becomes  easier  and  more  rapid,  but  it  is  attended 
with  less  mental  effort.    When,  for  instance,  we  first  attempt 


TIiE    MIND.  55 

to  commit  a  passage  to  memory,  we  read  it  through,  and 
then  Hfting  the  eyes  from  the  page  we  repeat  the  words, 
conscious  of  a  certain  mental  effort  in  doing  so.  Presently 
there  comes  a  hitch,  we  have  forgotten  the  context.  Tlie 
next  word  is  wanting.  A  powerful  mental  effort  is  made, 
and  the  word  is  recalled.  The  next  time  the  passage  is 
repeated,  the  hitch  again  occurs,  but  this  time  the  recall  is 
made  with  less  effort — the  mental  accomplishment  is  less 
vivid.  With  each  repetition,  not  only  is  the  difficulty  less, 
but  the  whole  mental  accompaniment  is  reduced.  At  first 
the  passage  made  a  powerful  impression  upon  us  by  the 
appropriateness  with  which  a  great  thought  w^as  clothed  in 
beautiful  words.  But  by  continual  repetition  the  beauty  of 
the  words  strikes  us  less  vividly  ;  and  the  grandeur  of  the 
thought  makes  less  impression  upon  us.  The  enthusiasm 
which  the  passage  at  first  inspired,  declines  by  degrees  into  a 
mild  commendation.  If  the  process  is  still  continued,  and 
the  passage  is  repeated  again  and  again,  it  is  found  that  after 
innumerable  repetitions,  not  only  does  the  emotion  at  first 
inspired  fail  to  arise,  not  only  do  the  words  flow  glibly  off 
the  tongue,  while  at  the  very  time  we  utter  them  we  may 
be  thinking  of  something  else,  but  at  length  we  cease  to 
attend  to  the  sense  of  the  Avords  at  all  ;  and  we  may  find 
that  continual  and  repeated  efforts  are  required  to  enable  us 
to  follow  with  our  minds  the  sense  of  the  words  that  we 
utter  so  readily.  Take  the  case  of  a  liturgy,  and  let  any  one 
who  has  habitually  used  the  same  form  of  words  Sunday 
after  Sunday  for  years  together,  say  if  it  is  possible  to  keep 
the  attention  from  wandering  while  the  words  are  being 
uttered.  Or  take  the  case  of  grace  said  daily  at  meals. 
Who  is  there  who  has  habitually  used  the  same  form  of 
words  for  years  that  can  without  effort  pay  any  attention  to 
the  thought  the  words  express  ?  Again,  the  child  learning 
to  read,  or  the  novice  learning  a  musical  instrument,  finds  at 
first  that  the  correct  articulation  of  each  word,  and  the 
correct  sounding  of  each  note,  requires  his  whole  attention, 
and  is  attended  by  a  separate  and  definite  mental  effort.    But 


56  SANITY    AND    INSANITY. 

after  years  of  practice  it  becomes  a  matter  of  course  to  read 
without  paying  the  smallest  attention  to  the  articulation  of 
the  words,  all  the  mental  accompaniment  being  that  of  the 
sense  they  convey.  And  similarly,  the  practised  musician 
never  thinks  what  note  he  has  to  play,  but  is  conscious  solely 
of  the  sounds  produced.  It  is  the  same  in  every  handicraft, 
and  what  is  true  of  every  handicraft  is  true  of  every  course 
of  conduct.  When  we  first  determine  to  pursue  a  new 
course  of  conduct,  the  mental  effort  is  considerable ;  we  have, 
as  we  say,  to  make  up  our  minds.  But  not  only  is  it  easier 
— attended  with  less  mental  exertion,  with  less  vivid  con- 
sciousness— to  take  that  course  again,  but  it  becomes  easier 
also  to  break  through  our  routine  of  conduct  in  other 
directions. 

Not  only  is  it  the  new  course  which  requires  the  greatest 
mental  effort  to  enter  upon  ;  not  only  is  it  the  novel  expe- 
rience which  most  vividly  impresses  us,  but,  as  might  be 
expected,  the  more  novelty  there  is  in  the  act  or  the  experi- 
ence, the  more  widely  it  differs  from  previous  acts  and 
previous  experiences,  the  more  vivid  is  the  mental  accom- 
paniment. Policemen,  who  are  accustomed  to  spend  their 
lives  on  their  feet,  with  their  hands  idle,  find  it  difficult  to 
learn  work  which  requires  the  use  of  the  fingers.  Women 
who  are  accustomed  to  work  with  the  fingers  are  extremely 
awkward  in  exercises  requiring  the  use  of  the  arm,  such  as 
throwing  a  ball,  playing  billiards,  and  so  forth.  To  learn 
such  exercises  they  have  to  pay  great  attention.  The  newer 
experience  has  the  more  vivid  mental  accompaniment.  A 
man  accustomed  to  the  outdoor  existence  and  scanty  society 
of  country  life,  finds,  when  he  spends  a  week  or  two  in  town, 
his  interest  and  attention  far  more  keenly  and  constantly  on 
the  alert  than  the  citizen  ;  and,  conversely,  the  latter,  remov^ed 
to  the  country,  is  aroused  and  excited  by  experiences  which 
to  his  country  friend  present  no  interest,  and  who  accounts 
for  his  lack  of  interest  by  the  explanation  that  he  is  ac- 
customed to  them. 

That  novelty  is  attractive  is  proverbial,  but  we  find  the 


THK    MIND.  57 

truth  is  wider  than  this,  the  fact  being  that  we  are  con- 
scious only  of  what  is  new.  Of  course  we  are  conscious  of  the 
landscape  that  we  see  from  our  windows,  though  we  may 
have  seen  it  every  day  for  fifty  years,  but,  for  all  that,  we  are 
conscious  of  it  only  because  it  is  relatively  new,  because  it  is 
a  change  from  the  object  last  looked  at,  because  our  eyes 
range  over  it  and  we  see  its  parts  differently.  If  we  were 
to  keep  our  eyes  continuously  fixed  on  one  point  of  it  for 
a  sufficient  length  of  time,  we  should  cease  to  be  conscious 
of  it. 

Since  states  of  mind  are  but  the  obverse  side,  or,  as  I  have 
termed  them,  the  shadows,  of  nervous  processes,  it  was  to 
be  expected  that  repetition,  which  has  so  great  an  effect  on 
nervous  processes,  should  have  an  effect  equally  great  on 
mental  states  ;  and  this  we  find  to  be  the  fact.  The  law 
is  that  a  new  nervous  process  is  attended  by  the  most  vivid 
mental  state  ;  and  that  the  more  unlike  the  nervous  process 
is  to  previous  processes,  the  more  vivid  is  the  mental  state 
that  accompanies  it.  With  nervous  processes  we  have  seen 
that  continual  repetition  brings  about  complete  organization 
— organization  so  complete  that  a  very  small  incentive  is 
required  to  start  the  process,  and  by  starting  the  process  to 
set  the  movement  going.  We  have  seen  how  new  acts  become 
habitual,  habitual  acts  automatic,  and  automatic  acts  reflex. 
We  have  now  to  notice  that  as  the  nervous  mechanism  sub- 
sides through  these  several  stages  from  a  nascent  to  a 
complete  state  of  organization,  so  the  mental  accompani- 
ment, at  first  vivid,  becomes  fainter  and  fainter,  until,  when 
the  latter  stages  are  reached,  it  altogether  disappears.  When 
an  act  has  become  habitual,  it  has  so  little  mental  accom- 
paniment that  as  we  put  our  watch  down  on  the  dressing- 
table  we  may  be  uncertain  whether,  the  instant  before,  we 
wound  it  up  or  not.  It  has  so  little  mental  accompaniment 
that  on  meeting  a  carriage  in  the  road  we  draw  the  near 
rein  to  the  required  extent  with  scarcely  a  consciousness 
— a  thought — of  what  we  are  doing.  When  the  act  becomes 
automatic,  and  still  more  when  it  becomes  reflex,  there  is  no 


58  SANITY    AND    INSANITY. 

appreciable  mental  accompaniment  to  the  discharge  of  the 
centre  that  actuates  the  movement  ;  though  there  may  be 
a  mental  accompaniment  to  the  movement  itself,  obtained 
in  other  ways.  For  instance,  the  fixed  mechanism  which 
actuates  such  movements  as  sneezing  or  swallowing  is  not 
only  cut  off  from  the  influence  of  the  highest  centres,  so  that 
no  amount  of  focussing  or  concentration  of  energy  there — ■ 
no  effort,  as  we  say,  of  will — can  produce  them  ;  but  the 
action  of  these  mechanisms  is  attended  by  no  mental  mani- 
festation. We  know  that  we  are  sneezing,  and  that  we  have 
sneezed,  by  intelligence  arriving  from  the  periphery  ;  but 
the  instant  before  the  sneeze  happens,  we  cannot  say  when 
it  will  happen,  or  even  that  it  will  take  place  at  all. 

Hence  it  appears,  since  the  most  fixedly  and  completely 
organized  centres  are  the  lowest,  and  the  most  recent  and 
least  organized  are  the  highest,  that  the  mental  accom- 
paniment of  the  nervous  discharge  gradually  increases 
in  vividness  from  the  lowest  centres  to  the  highest. 
Quite  at  the  bottom  are  the  mechanisms  actuating 
directly  the  movements  of  the  heart  and  other  viscera, 
which  are  in  health  absolutely  void  of  mental  accom- 
paniment ;  above  these  are  the  mechanisms  for  breathing, 
swallowing,  and  other  reflex  actions ;  and  with  their  activity 
a  faint  glimmering  of  consciousness  is  occasionally  per- 
ceptible. Above  these  again  are  layer  upon  layer  of 
mechanisms  actuating  automatic  and  habitual  acts  of  every 
degree  of  fixity  ;  and  with  their  action  appears  a  certain 
amount  of  consciousness,  broadening  from  a  mere  glimmer 
at  the  bottom,  through  an  ever-lightening  twilight,  to  full 
dawn  at  the  top.  The  action  of  the  highest  centres  is 
accompanied  by  the  broad  daylight  of  wakeful  consciousness, 
and  the  occasional  concentration  of  energy  in  particular 
tracts,  and  the  vigorous  and  energetic  discharge  of  these 
tracts  from  time  to  time,  are  accompanied  by  mental  states 
of  exceptional  vividness,  which,  in  comparison  with  the  usual 
more  quiescent  condition  of  consciousness,  may  be  hkened 
to  bursts  of  sunshine  on  a  cloudy  day. 


THE    MIND.  59 

The  preceding  sentence  introduces  to  our  notice  another 
factor  in  the  nervous  process  that  influences  the  vividness 
of  the  accompanying  mental  state.  The  latter  depends 
greatly  indeed  upon  the  novelty,  but  it  depends  also  in  large 
measure  upon  the  intensity  of  the  nervous  process.  When 
the  nervous  process  is  feeble,  the  mental  accompaniment  is 
faint ;  when  the  nervous  process  is  forcible,  the  mental  accom- 
paniment is  vivid.  An  instance  of  this  has  already  been 
given.  It  was  stated  that  when  the  arm  is  moved,  the 
nervous  process  actuating  the  movement  has  for  its  mental 
accompaniment  an  idea  of  the  movement ;  and  that  when 
the  same  nervous  process  occurred,  but  with  an  intensity 
insuflScient  to  produce  a  movement,  there  was  still  an  idea 
of  the  movement,  but  the  idea  was  faint  in  proportion  to 
the  lessened  activity  of  the  nerve  centre.  It  is  the  same 
on  the  sensory  side.  If  I  look  at  the  lawn  in  front  of  me, 
the  impression  carried  through  the  eyes  to  the  higher  centres 
rouses  the  activity  of  a  certain  nervous  region,  and  this 
activity  has  for  its  mental  shadow  a  feeling  of  green  in  the 
mind.  If  I  lower  my  eyes  again  to  the  paper  I  can  still 
think  of  the  green  lawn — I  can  still  have  in  my  mind, 
though  in  a  much  less  vivid  degree,  the  feeling  of  green — 
and  I  know  that,  for  this  feeling  to  arise,  there  must  be 
activity  of  the  same  nerve-region  as  before.  This  time,  as 
the  activity  is  much  less  energetic,  so  the  feeling  is  cor- 
respondingly less  vivid. 

The  difference  between  a  central  nervous  process  set  in 
motion  directly  by  an  impression  from  without,  and  a  similar 
process  originated  by  the  far  less  intense  stimulus  of  an 
internally  initiated  current,  is  considerable ;  and  the  differ- 
ence in  vividness  of  the  two  states  of  mind,  the  difference 
between  the  colour  that  we  say  we  see  and  the  colour  that 
we  say  we  remember  or  imagine  is  correspondingly  great. 
But  there  are  minor  differences  of  vividness  in  the  mental 
states,  corresponding  with  minor  differences  in  the  activity 
of  the  nervous  process.  Thus  if,  while  I  am  looking  at  the 
grass,  the   sun  shines    out,  a  more   powerful  impression  is 


6o  SANITY    AND    INSANITY. 

made  upon  the  eye,  a  more  energetic  discharge  of  the 
nervous  centre  is  evoked,  and  a  more  vivid  feehng  of  green 
arises  in  the  mind;  and,  generally,  the  vividness  of  the 
mental  state  varies  directly  as  the  intensity  of  the  impression 
that  evokes  the  nervous  process,  and  therefore  varies  as  the 
intensity  of  that  process  itself. 

There  are  also  intrinsic  causes  of  difference  in  the  activity 
of  the  nervous  process.  When  the  tide  of  nervous  energy 
is  at  its  height,  as  v/hen  the  body  is  in  robust  health,  and 
after  the  recuperation  of  sleep,  and  before  the  daily  expendi- 
ture has  become  considerable,  the  discharge  of  the  highest 
nervous  centres  is,  coeterts  paribus^  of  greater  activity  than 
towards  the  close  of  day,  when  the  tide  is  ebbing  and  the 
expenditure  of  the  diy  has  left  the  nerve  cells  depleted  of 
much  of  their  store  of  energy.  Hence  we  find  that,  in  the 
morning,  the  same  impression  evokes  a  more  vivid  mental 
condition  than  in  the  evening.  We  find  that  the  morning 
is  the  time  to  work  out  difficult  problems,  to  appreciate  fine 
shades  of  difference,  to  commit  things  to  memory,  and, 
generally,  to  perform  those  tasks  in  which  the  maximum 
of  mental  exertion  is  required  on  the  minimum  of  impres- 
sion from  without.  In  the  evening  a  stronger  stimulus  is 
needed  to  produce  a  mental  condition  of  equivalent  intensity, 
and  hence  we  find  the  evening  devoted  to  those  occupations 
in  which  the  main  element  is  the  impression  given  from 
without.  The  evening  is  the  time  at  which  we  enjoy  lis- 
tening to  music,  witnessing  spectacular  displays,  and  re- 
ceiving in  other  ways  powerful  impressions  on  the  senses. 

The  same  law — that  the  vividness  of  the  mental  condition 
depends  on  the  activity  of  the  nervous  process — is  exem- 
plified in  the  fact  that  in  states  of  great  excitement,  when 
the  activity  of  the  highest  centres  is  at  its  maximunij  im- 
pressions produce  effects  out  of  all  proportion  to  their  mag- 
nitude, and  to  the  mental  states  which,  on  common  occasions, 
accompany  them.  Thus  it  is  commonly  said  that  a  position 
of  great  danger  calls  forth  all  a  man's  faculties  ;  the  fact 
being  that  the  state  of  excitement  in  which  he  is — the  state 


THE    MIND.  6 1 

of  high  tension  of  his  nervous  system — enables  new  combina- 
tions of  centres  to  be  effected,  which  the  ordinary  nervous 
tide  would  be  insufficient  to  accomplish  ;  just  as  we  see  that 
an  extraordinarily  high  tide  in  the  Thames  will  not  only 
overflow,  but  will  break  down  barriers  which  are  a  sufficient 
defence  against  ordinary  tides.  These  new  combinations 
are,  ex  hypothesis  of  greater  novelty  than  usual,  and  hence 
on  that  account  have  a  more  vivid  mental  accompaniment  ; 
but  this  is  not  all.  The  ordinary  processes,  such  as  arc 
in  daily  and  hourly  working,  are  all  intensified,  and  their 
accompanying  mental  states  share  in  the  intensification. 
It  is  a  common  observation  that  in  moments  of  great  danger, 
great  anxiety,  great  excitement  of  any  kind,  the  mind 
acquires  an  extraordinary  wakefulness,  and  the  entire  scene, 
in  which  the  individual  is  placed,  impresses  itself  to  the 
minutest  detail  upon  him,  with  an  intensity  which  becomes 
painful.  Dickens  has  described  in  the  trial  of  Fagin  a 
mental  experience  which  most  people  have  undergone  in 
some  degree.^     In  such  cases  there  is  of  course  no  increase 

"^  "  He  looked  up  into  the  gallery  again.  Some  of  the  people  were 
eating,  some  fanning  themselves  with  handkerchiefs  ;  for  the  crowded 
place  was  very  hot.  There  was  one  young  man  sketching  his  face  in  a 
little  note-book.  He  wondered  whether  it  was  like  him,  and  looked  on 
when  the  artist  broke  his  pencil-point  and  made  another  one  with  his 
knife,  as  an  idle  spectator  might  have  done. 

"  In  the  same  way  when  he  turned  his  eyes  towards  the  judge,  his  mind 
began  to  busy  itself  with  the  fashion  of  his  dress,  and  what  it  cost,  and  how 
he  put  it  on.  There  was  an  old  fat  gentleman  on  the  bench,  too,  who  had 
gone  out,  some  half-an-hour  before,  and  now  come  back.  He  wondered 
within  himself  whether  this  man  had  been  to  get  his  dinner,  what  he  had 
had,  and  where  he  had  had  it ;  and  pursued  this  train  of  careless  thought 
until  some  new  object  caught  his  eye  and  roused  another. 

"  Not  that,  all  this  time,  his  mind  was  for  an  instant  free  from  one 
oppressing,  overwhelming  sense  of  the  grave  that  opened  at  his  feet ;  it 
was  ever  present  to  him,  but  in  a  vague  and  general  way,  and  he  could  not 
fix  his  thoughts  upon  it.  Thus  even  when  he  trembled  and  turned  burning 
hot  at  the  idea  of  speedy  death,  he  fell  to  counting  the  iron  spikes  before 
him,  and  wondering  how  the  head  of  one  had  been  broken  off,  and 
whether  they  would  mend  it  or  leave  it  as  it  was." 

This  vivid  description  well  portrays  the  elevation  of  sub- conscious  into 
wholly- conscious  states  under  the  influence  of  great  excitement. 


62  SANITY   AND   INSANITY. 

in  the  strength  of  the  impression  that  is  made.     The  cir- 
cumstances are  the  same,  and  their  action  on  the  organism 
is  the  same  as  usual,  but  the  increased  tension  of  the  nervous 
system  causes  an  exaggerated  action  on  the  receipt  of  an 
ordinary  impression,  and  this  exaggerated    nervous   action 
has  for  its  accompaniment  an  exaggerated  mental  condition. 
Upon  the  novelty  and  upon  the  activity  of  the  nerv^ous 
process,  depend,  therefore,  the  degree  of  consciousness  with 
which  the  nervous  process  shall  be  accompanied.     It  is  pro- 
bable that,  upon  consideration,  this  expression  may  be  yet 
further  simplified,  and  that  the  mental  accompaniment  may 
be  found  to  depend  upon  a  single  factor  in  the  nervous 
process.     For  we  have  seen   that  the  distinction  between 
a  new  and  an  old  nervous  process  is  that,  while  the  latter 
proceeds  in  old-established,  well-worn  channels,  thoroughly 
organized,  fixed  in  character,  and  of  calibre  adapted  to  the 
volume  of  the  current  they  have  to  carry;  the  former  proceeds 
in  channels  that  are  new,  that  are  but  little  differentiated 
from  the  ground  substance  in  which  they  run,  that  are  but 
faintly  and  inefficiently  divided  from  this  ground  substance, 
that  are  but  slightly  organized,  and  therefore  easily  modified, 
and  that   are   insufficient   in  calibre  to  contain  the  whole 
volume  of  the  current.     The  essential    difference   between 
the  old  process  and  the  new  is  that  the  former  proceeds  in 
established  channels,  while  the  latter  proceeds  partly  in  the 
ground    substance.     The   essential   difference   between    the 
feeble  process  and  the  vigorous  process  is  that  the  former 
entirely  proceeds  in  established  channels,   while   the  latter 
breaks    their    bounds    and   escapes   into    the   ground    sub- 
stance.    Hence  it  is  probable  that   the  common  factor  in 
the  two  conditions  is  that  which  determines  the  common 
accompaniment,  and  that  the  factor  in  the  nervous  process 
on    which    the    concomitant    occurrence   of    consciousness 
depends,  is  the  passage  of  the  nerve  current  through  the 
ground  substance  of  the  grey  matter. 

Such  being  the  condition   upon  which  consciousness  in 


THE    MIND.  63 

general  depends,  it  remains  to  show  what  are  the  variations, 
or  special  modes,  or  characters  in  the  nervous  process,  upon 
which  depend  the  various  manifestations  of  consciousness 
which  we  know  by  the  names  of  Memory,  Thought,  Reason, 
Will,  Imagination,  Emotion,  and  so  forth.  In  order  to  do 
this  effectually,  it  will  be  necessary  to  give  first  a  brief 
account  of  the  general  constitution  of  mind  and  the  nature 
of  the  various  faculties  of  which  it  consists. 

If  we  look  into  our  own  minds  and  observe  what  goes 
on  there,  we  shall  find  that  the  entire  content  or  factors 
of  consciousness  fall  into  two  groups.  When  I  glance  from 
the  green  lawn  in  front  of  me  to  the  blue  sky  above,  I  am 
conscious  of  a  feeling  of  green,  of  a  feeling  of  blue,  and  of 
a  change  from  one  feeling  to  the  other.  When  I  hear  two 
notes  struck  in  succession  on  the  piano,  I  am  conscious  first 
of  one  sound,  then  of  the  other,  and  of  the  change  from  one 
to  the  other.  The  door  opens  and  a  blast  of  cold  air  enters.i^ 
From  the  feeling  of  warmth  that  I  had  a  moment  ago,  I  now  '  •  , 
become  conscious  of  a  feeling  of  cold,  and  distinct  from  each  i^^^j^f^ 
is  the  consciousness  of  the  change  from  one  to  the  other. 
In  thinking  over  the  events  of  yesterday  I  recall  the  feeling 
of  disappointment  that  I  had  when  a  friend  failed  to  keep 
an  appointment,  and  the  feeling  of  pleasure  that  arose  when 
I  received  a  letter  from  him  bearing  good  news,  and  I  am 
aware  of  a  change  from  the  feeling  of  disappointment  to  the 
feeling  of  pleasure.  In  thinking  of  the  case  that  I  saw  this 
morning,  the  recollection  of  the  various  symptoms  that  it 
presented  forms  a  highly  complex  state  of  mind  ;  and  in 
passing  from  this  recollection  to  the  recollection  of  other 
cases,  I  am  aware  successively  of  several  highly  complex 
states  of  mind,  and  of  the  changes  from  state  to  state.  The 
same  factors  are  present  in  all  conditions  of  consciousness. 
When  the  silence  is  broken  by  a  knock  at  the  door,  I  hear 
the  knock,  I  have  a  feeling  of  noise,  and  at  the  same  time 
become  conscious  of  the  change  from  silence  to  noise,  and 
from  noise  to  silence.  When  I  open  my  eyes  after  sleep, 
I  am  aware  of  the  feelings  of  light  and  colour,  and  of  the 


riiJl 


64  SANITY   AND   INSANITY. 

change  from  darkness  to  light.  Similarly,  Avhen  I  wake  out 
of  sleep,  I  am  conscious  of  many  vivid  feelings,  and  of  the 
change  from  a  consciousness  of  but  few  faint  feelings,  such 
as  I  had  during  sleep,  to  the  waking  consciousness  of  many 
vivid  ones.  Throughout  the  whole  of  conscious  life  we 
know  of  but  two  factors — states  of  mind,  and  changes  from 
one  state  to  another. 

If  the  matter  is  considered,  it  will  be  found,  not  only  that 
there  can  be  no  change  of  consciousness  without  a  state 
from  which,  and  an  adjoining  state  to  which,  the  change  is 
made  ;  but  also  that  there  can  be  no  state  of  consciousness 
which  is  not  bounded  by  changes.  Not  only  does  the  con- 
stant procession  of  thoughts,  which  we  find  ever  passing 
through  our  minds,  necessitate  the  change  from  one  state  of 
consciousness  to  another  ;  but,  if  we  try  to  maintain  one 
state  of  mind  unchanged,  we  are  unable  to  do  so.  In 
noticing  the  simplest  thing,  we  are  continually  passing  from 
the  observation  of  its  form  to  that  of  its  colour,  from  its 
colour  to  its  position,  from  its  position  to  its  surroundings, 
from  its  entirety  to  its  parts.  If  we  wilfully  determine  to 
fix  our  attention  on  one  of  these  factors  to  the  exclusion  of 
others,  and  if  we  succeed  in  doing  so,  then  the  intercalated 
mental  states  refer  to  something  else,  to  other  similar 
objects,  to  other  similar  occasions  on  which  we  made  similar 
attempts,  to  things  wholly  unconnected  with  the  object 
before  us — to  yesterday's  weather  or  to  to-morrow's  excur- 
sion. What  is  true  of  states  of  mind  which  we  voluntarily 
bring  up,  is  true  of  states  of  mind  impressed  upon  us  from 
without.  The  continuous  roar  of  a  cataract,  the  continuous 
clacking  of  a  mill,  the  continuous  rumbling  of  carts  through 
the  streets,  become  at  length  inaudible  to  those  who  live 
beside  them  and  are  never  free  from  their  influence. 
Originally  they  were  almost  continually  audible,  the  feeling 
of  sound  obtruding  itself  continually  into  the  series  of 
mental  states.  As  it  became  more  accustomed,  it  intruded 
less  and  less  often,  until  at  last  attention  must  be  specially 
directed  to  it  for  it  to  be  heard.     But  if  now  the  noise  sud- 


THE   MIND.  65 

denly  ceases,  if  the  mill  is  stopped,  or  the  traffic  is  diverted 
for  the  repair  of  the  road,  this  change  is  at  once  responded 
to  by  a  change  in  consciousness.  Not  only  is  the  sudden 
accession  of  silence  felt,  but  in  being  felt  it  brings  a  know- 
ledge, till  then  obscured  and  unnoticed,  of  the  sound  which 
preceded  it. 

These  two  conditions,  therefore, — states  of  mind  and 
changes  of  state — compose  the  entire  content  of  conscious- 
ness, and  each  of  them  is  indispensable  to  consciousness  ; 
without  either  of  them  consciousness  could  not  exist. 

If  we  examine  each  factor  separately,  we  find  that  while  in 
one  respect  they  are  similar,  in  other  respects  they  are  very 
different.  They  are  similar  in  this,  that  although  they  are 
here  called  differently,  states  and  changes  of  state,  yet  upon 
ultimate  analysis  a  change  from  one  state  of  mind  to  another 
is  itself  a  state  for  the  moment  for  which  it  lasts.  Their 
differences,  however,  are  much  more  marked.  States  of 
mind  are  infinitely  various,  various  in  kind,  various  in  com- 
plexity, various  in  intensity,  infinite  in  number  ;  some  being 
crude  sensations,  as  of  colour  or  sound  or  touch  ;  others 
emotions,  as  hope,  and  joy,  and  fear — vexation,  anxiety,  and 
sympathy  ;  others,  again,  are  recollections,  as  of  a  particular 
room  or  landscape,  at  a  particular  time,  under  a  particular 
aspect  ;  others  are  theories  and  hypotheses  of  various  kinds  ; 
indeed,  the  whole  bulk  of  our  consciousness  is  made  up  of 
states  of  mind  ;  the  changes  of  state  can  be  but  the  dividing 
lines  which  separate  the  states  from  one  another. 

Changes  of  state,  or,  as  we  may  hereafter  term  them,  rela- 
tions between  states,  differ  from  the  states  themselves  in 
being  but  two  in  number.  The  change  may  be  from  one 
state  of  mind  to  a  different  state,  as  from  a  feeling  of  blue  to 
a  feeling  of  red,  or  from  a  recollection  of  a  poem  to  a 
feeling  of  anger,  or  from  the  percept  of  a  running  rabbit  to 
the  concept  of  a  gun,  or  from  the  percept  of  a  rod  of  a  cer- 
tain length  to  the  percept  of  a  rod  of  a  different  length,  or 
from  the  percept  of  an  article  of  a  certain  quality  or  price 
to  that  of  an  article  of  a  different  quality  or  price,  or  from  a 

6 


66  SANITY   AND   INSANITY. 

certain  conceived  method  of  dealing  with  circumstances  to 
a  different  method.  Or  the  change  may  be  from  one  state 
of  mind  to  a  similar  state,  as  from  a  feeling  of  blue  to  a 
feeling  of  the  same  shade,  or  from  a  percept  of  a  certain 
area  or  length,  to  that  of  a  similar  area  or  length,  or  from 
the  percept  of  an  article  of  certain  quality  or  price  to  the 
concept  of  other  articles  of  the  same  quality  or  price,  and  so 
forth.  The  fact  is,  that  there  are  only  two  possible  changes 
from  one  state  of  mind  to  another,  one  to  a  similar,  the 
other  to  a  different  state  of  mind.  Thus  our  notion  of  the 
contents  of  consciousness  becomes  somewhat  more  detailed. 
Consciousness  consists  of  successive  states  of  mind,  and  of 
changes  from  one  state  to  another  ;  of  conscious  states,  and 
conscious  likenesses  and  differences  between  states ;  of 
states,  and  of  relations  of  likeness  and  difference  between 
them.  The  states  of  mind  are  called  fee h'n^s,  and  the  rela- 
tions between  them  are  called  thoiigJits^  and  out  of  feelings 
and  thoughts  all  consciousness  is  made  up. 

We  have  next  to  notice  that  while  mind  is  made  up  of 
both  feelings  and  thoughts,  and  while  there  can  be  no 
feeling  without  thought,  and  no  thought  without  feeling, 
yet  feeling  and  thought  are  rarely  or  never  equally  pre- 
dominant in  consciousness.  One  element  or  the  other 
preponderates. 

Let  us  take  a  very  simple  case.  Take  the  case  of  the 
feelings  of  sound  and  their  allied  thoughts.  A  musical  note, 
followed  by  another  note,  arouses,  as  we  have  seen,  three 
conscious  states.  There  is  first  a  feeling  of  sound  ;  then 
another  feeling  of  sound  ;  and  in  addition  to  these  two 
feelings  there  is  a  consciousness  of  the  likeness  or  unlikeness 
between  them  ;  of  the  sameness  or  difference  of  pitch,  or 
of  loudness,  or  of  timbre.  So  long  as  consciousness  is 
occupied  with  this  or  that  sound,  so  long  there  is  feeling 
pure  and  simple  ;  but  directly  we  become  aware  that  this 
note  is  louder  than  that,  or  that  that  is  shriller  than  this — 
directly  we  attend,  not  to  the  feelings  themselves,  but  to 
the  relation   between   them — we  are  forming  a  judgment. 


THE    MIND.  67 

The  attitude  of  feeling  has  passed  into  the  attitude  of 
thought.  It  is  clear  that  neither  the  feeling  nor  the  thought 
can  exist  alone.  In  every  state  of  consciousness  there  is 
both  feeling  and  thought,  but  the  two  are  never  equally 
prominent  in  consciousness.  The  varying  condition  of  con- 
sciousness, in  Avhich  the  limiting  terms  and  the  relation 
between  them  alternately  rise  into  prominence,  may  be 
represented  by  F  r  F  and/"  R  f.  Now,  if  the  two  notes  are 
struck  simultaneously,  a  new  state  of  consciousness  arises, 
differing  from  each  of  the  three  previous  states.  It  is  a  state 
compounded  of  the  two  feelings  and  of  the  relation  between 
them.  When  a  note  and  its  third,  or  fifth,  or  octave,  are 
struck  simultaneously,  we  are  aware  of  two  sounds  and  of  a 
difference  in  pitch  between  them.  Yet  the  three  states  of 
consciousness  are  blended  so  intimately,  that  the  chord  affects 
us  as  a  single  sound.  The  three  states  have  become  con- 
solidated into  one.  The  single  state  thus  formed  can  enter 
as  a  unit  into  relation  with  other  mental  states.  It  can 
behave  in  every  way  as  a  simple  feeling.  It  is,  in  fact,  a 
compound  feeling.  Suppose  one  such  chord  to  be  followed 
by  another,  then,  precisely  as  in  the  simpler  case,  there  is  a 
feeling,  followed  by  another  feeling  and  separated  by  a 
relation  ;  and  just  as  in  the  previous  case,  the  feeling  or 
the  relation  may  chiefly  occupy  consciousness — may  be  the 
prominent  component  of  the  conscious  state.  If  we  are 
affected  chiefly  by  the  pleasing  or  harsh  sound  of  the  chords, 
the  conscious  state  is  one  mainly  of  feeling.  If  we  notice 
chiefly  the  similarity  or  difference  in  loudness,  or  pitch,  or 
harmony  of  the  two  chords,  the  conscious  state  is  one  mainly 
of  thought.  The  symbols  representing  the  two  states  of 
consciousness  would  be  (F  r  F)  r  (F  r  F)  where  the  element 
of  feeling  is  conspicuous  and  the  relational  element  insigni- 
ficant ;  and  (f  r  f )  R  (f  r  f )  where  the  relation  between  the 
chords  is  conspicuous  and  the  element  of  feeling  neglected. 

But  these  are  not  the  only  relations  that  can  be  established 
between  the  two  chords.  Consciousness  may  be  occupied  with 
the  comparison  of  the  interval  between  the  first  pair  of  notes 


68  SANITY    AND    INSANITY. 

and  the  interval  between  the  second.  The  interval  between 
the  first  pair  may  be  a  third,  and  that  between  the  second  pair 
may  be  a  fifth,  and  consciousness  may  be  occupied  with  the 
difference  between  these  two  intervals.  But  each  of  these  two 
intervals  is  itself  a  relation  between  the  pitch  of  one  note  and 
the  pitch  of  another  ;  so  that  consciousness  is  occupied,  not  with 
a  relation  between  feelings,  as  in  the  previous  cases,  but  with 
a  relation  between  relations.  In  graphic  form  the  symbol 
for  such  a   state   of  consciousness   would    be    (f  'R  f)   R 

(/R/). 

We  may  imagine  each  of  the  terms  of  this  relation  to  be 
composed  of  the  feelings  aroused  by  chords  of  three  or  more 
notes  ;  each  additional  note  adding  to  the  complexity  of  the 
feeling,  each  more  complex  feeling  adding  to  the  complexity 
of  the  state  of  mind  which,  together  with  another  feeling 
and  a  relation,  it  constitutes  ;  and  each  such  state  of  mind 
being  capable,  when  consolidated  into  a  single  feeling,  of 
entering  into  relation  with  yet  another  feeling,  and  so  con- 
stituting a  state  of  consciousness  of  still  higher  complexity. 
When  to  differences  of  pitch,  loudness,  and  number  of 
simultaneous  sounds,  are  added  differences  in  the  succession 
of  sounds  ;  the  states  of  mind,  the  feelings  into  which  they 
are  consolidated,  and  the  higher  and  higher  orders  of  states 
into  which  they  become  combined,  reach  a  very  great  degree 
of  complexity  ;  and  when  to  these  differences  are  added 
differences  of  timbre,  by  the  employment  of  different  instru- 
ments, the  complexity  of  the  states  of  consciousness  is  still 
further  increased.  Yet,  even  if  the  content  of  consciousness 
is  the  comparative  merits  of  two  operas,  each  executed  by  a 
full  orchestra,  each  consisting  of  many  parts,  each  performed 
by  many  vocalists,  each  occupying  two  or  three  hours  in  its 
performance  ;  it  is  easy  to  see  that  the  judgment  arrived  at 
as  to  their  merits  is  precisely  the  same  in  form  as  the  judg- 
ment of  the  superiority  in  harmony  of  one  chord  to  another  ; 
and  that  the  form  of  the  content  of  consciousness  is  still 
R.  In  the  one  case  as  in  the  other  there  is  a  relation 
between  two  terms.     In  the  one  case  the  terms  are  extremely 


THK   MIND.  69 

simple,  in  the  other  they  are  extremely  complex,  but  the 
judgment  still  consists  in  the  establishment  of  a  relation 
between  two  terms. 

Such  being  the  universal  form  of  all  thought,  it  remains 
to  compare  the  mental  process  with  the  process  in  the 
highest  nervous  centres  of  which  the  former  is  the  shadow, 
and  see  if  these  two  have  any  features  in  common.  In 
examining  the  way  in  which  the  nervous  centres  act,  we 
found  that  at  the  turning  point  at  which  the  ingoing  current 
from  the  sense  organs  is  reflected  as  the  outgoing  current  to 
the  muscles,  there  is  interposed,  in  the  lowest  levels  of  the 
series,  a  patch  of  grey  matter  at  which  the  current  is 
reflected  and  by  which  it  is  reinforced.  But  at  the  highest 
levels  we  found  a  duplication  of  the  patch  of  grey  matter. 
The  ingoing  current  is  received  by  one  centre,  which  then 
transmits  its  discharge  to  another  centre,  whose  activity  sets 
the  muscles  in  action.  The  process  in  the  highest  centres  is 
therefore  threefold.  There  is  the  discharge  of  a  centre,  the 
passage  of  the  discharge  through  channels,  and  the  discharge 
of  a  second  centre.  And  it  is  this  activity  which  is  accom- 
panied by  consciousness,  whose  form,  as  we  have  already  seen, 
is  similarly  threefold.  Hence  it  is  a  natural  inference  that 
the  feelings  are  the  mental  accompaniments  of  discharges  of 
grey  matter,  while  the  relations  between  the  feelings  are  the 
mental  accompaniments  of  the  passage  of  the  discharge 
through  channels  from  one  centre  to  another.  This  infer- 
ence will  appear  the  more  justifiable  when  we  remember  that 
it  is  the  passage  of  the  discharge  through  the  channels  that 
brings  into  relation  the  discharges  of  the  two  centres. 

Feelings,  therefore,  accompany  discharges  of  grey  matter. 
Thoughts  accompany  the  passage  of  discharges  from  centre 
to  centre.  Feelings  are  intense  when  discharges  are  vigorous  ; 
are  voluminous  when  discharges  are  widespread  ;  and  are 
complex  when  the  discharging  centres  are  complex  in 
structure.  Thoughts  are  similarly  complex  when  the 
channels  in  which  the  discharge  travels  are  numerous  and 
intricate  ;  are  vivid  when  the  discharge  is  of  high  tension  ; 


70  SANITY    AND   INSANITY. 

and  are  more  intense,  the  less   permeable  the  channels   in 
which  the  discharge  flows. 

When  thought  is  complex  and  novel,  it  is  termed  imagina- 
tion ;  and  the  conditions  in  the  nervous  system  that  are 
active  during  imagination  will  be  gathered  from  what  has 
gone  before. 

Memory  is  the  recurrence  of  a  mental  state  that  has 
occurred  before.  It  is,  on  the  bodily  side,  the  revivescence  of 
a  nervous  process  that  has  previously  been  active.  It  is 
obvious  that  this  physical  process  may  occur  both  in  centre 
and  in  channels,  and  so  we  can  remember  both  feelings  and 
thoughts.  It  has  been  already  shown  how  repetition  of  a 
nervous  process  acts  in  rendering  the  process  more  facile 
and  more  rapid,  and  how,  as  facility  and  rapidity  of  the 
nervous  process  increase,  the  mental  accompaniment 
diminishes  ;  and  thus  we  are  prepared  to  find,  not  only 
that  the  more  often  a  thing  has  been  repeated,  the  better  we 
remember  it,  but  that  the  more  perfectly  it  is  remembered, 
the  less  effort — the  less  consciousness — we  have  of  its 
remembrance  ;  until,  when  memory  becomes  perfect,  it 
ceases  to  become  conscious  —  we  cease  to  consider  it 
memory.  Thus,  I  remember  with  effort  the  name  of  the 
person  to  whom  I  was  introduced  yesterday  ;  I  remember 
without  difficulty  the  name  of  my  friend  of  a  year's  standing ; 
but  it  would  be  inappropriate  to  say  that  I  remember  that 
the  name  of  this  thing  on  the  plate  before  me  is  bread. 
Similarly,  I  remember  with  effort  the  way  to  tie  a  turk's 
head  ;  I  rem.ember  more  readily,  how  to  make  a  clove  hitch  ; 
but  it  would  be  inappropriate  to  say  that  I  remember  how  to 
tie  a  knot.  Thus  conscious  memory  fades  and  merges  into 
unconscious  memory,  and  the  more  perfect  the  memory  is, 
the  less  of  consciousness  accompanies  it.  When  memory  is 
looked  at  from  this  point  of  view,  as,  on  the  physical  side, 
the  repetition  of  a  nervous  process  that  has  occurred  before, 
and,  on  the  mental  side,  the  conscious  accompaniment  of 
this  process  where  it  has  a  conscious  accompaniment ;  the 
scope    and     meaning    of    the    term    become    considerably 


THE   MIND.  71 

extended,  and  a  community  of  origin  and  of  nature  is  found 
to  exist  between  processes  that  are  at  first  sight  widely 
different.  All  automatic  actions — the  movement  of  the  legs 
in  walking,  of  the  fingers  in  writing,  of  the  lips  and  tongue 
in  speaking — are  actions  whose  memory  has  become  perfect, 
and  therefore  unconscious.  The  movement  of  the  newly- 
hatched  chick,  in  pecking  at  food  a  few  hours  after  birth, 
has  been  called  a  remembrance.  It  is  said  that  the  chick 
remembers  how  its  parents  pecked  ;  and  this  statement,  at 
first  sight  fanciful,  is,  if  we  adopt  this  view  of  memory, 
almost  accurate.  For  the  chick  inherits  a  fully  formed 
nervous  structure,  which,  when  set  in  action,  produces  the 
movement  of  pecking.  Such  a  structure  can  have  been 
formed  in  the  ancestral  fowls  only  by  continual  repetitions  of 
the  act  ;  repetitions  that  were  at  first  accompanied  by 
conscious  memories,  and  subsequently  became  automatic. 
In  the  newly-hatched  chick  the  movement  is  evidently 
preceded  by  hesitation,  it  is  at  first  tentative  and  imperfect, 
and  only  after  repetition  attains  its  perfect  precision.  Every 
one  of  the  acts  is,  however,  actuated  by  the  repetition  or 
revivescence  or  recurrence  of  a  nervous  process,  and  is 
therefore,  on  the  physical  side,  a  case  of  remembrance  ;  and 
no  one  can  doubt,  who  has  seen  the  hesitation,  the  delibera- 
tion, and  the  manifest  tentativeness  of  the  first  few  pecks, 
that  they  are  accompanied  by  consciousness — by  conscious 
states,  which  are,  in  such  a  case,  memories.  In  the  same  way, 
the  vast  bulk  of  the  content  of  our  consciousness  at  any 
time  consists  of  memories.  The  judgments  that  we 
continually  and  sub-consciously  form  of  the  distances  of  all 
objects  that  we  see  around  us,  are  made  up  of  the  memories 
of  the  amount  of  stretching  or  reaching,  or  of  the  number  of 
steps,  or  of  the  time  taken  to  traverse,  the  intermediate 
distance  between  us  and  objects  similarly  related  to 
us,  on  innumerable  previous  occasions.  The  similarly 
sub-conscious  instant  judgments  that  we  continually 
form  of  the  direction  of  objects,  is  similarly  constituted  of 
memories  of  the  direction  of  efforts  made  to  reach   objects 


72  SANITY   AND   INSANITY. 

similarly  placed  with  reference  to  ourselves,  and  similarly 
appearing.  Our  ideas  of  the  solidity,  of  the  hardness  and 
softness,  roughness  and  smoothness  of  bodies,  are  similarly 
made  up  of  memories  of  the  sensations  that  we  have  had  in 
handling  bodies  of  similar  appearance  and  surface.  It  is  the 
same  with  more  complex  judgments.  Our  decision  as  to  the 
probable  qualities  of  a  horse,  is  made  up  of  memories  of  the 
qualities  of  horses  having  similar  points  ;  we  decide  as  to  the 
healthiness  of  a  house  by  memories  of  the  salubrity  of 
other  houses  similarly  situated  ;  and  as  to  the  prudence  of  a 
line  of  conduct,  by  memories  of  the  consequences  of  other 
lines  of  conduct  previously  pursued.  Similarly  again  on  the 
bodily  side,  the  skill  with  which  we  perform  any  operation, 
depends  upon  the  accuracy  with  which  we  remember  the 
amount  of  previous  efforts  and  thdr  results,  and  on  the 
precision  with  which  we  reproduce  them.  But  to  reproduce 
an  action  is  to  have  over  again  an  activity  of  the  same 
nervous  process  which  produced  it  before — that  is,  to 
remember  the  action.  From  every  point  of  view,  then,  we 
see  the  importance  of  memory.  Of  fully  conscious  memory, 
which  is  the  early  repetition  of  a  newly  formed  nervous 
process,  accompanied  by  vivid  consciousness ;  of  sub- 
conscious memory,  which  is  the  repetition,  after  very  many 
times,  of  a  well-organized  nervous  process,  accompanied  by 
faint  consciousness  ;  and  of  unconscious  memory,  which  is 
the  repetition  after  innumerable  times,  of  a  completely 
organized  nervous  process,  unaccompanied  by  any  conscious- 
ness. 

As  has  been  so  often  said,  a  nervous  process,  once 
established,  tends  to  occur  again.  But  this  is  not  all. 
Since  each  of  these  higher  nervous  processes  consists 
of  the  discharge  of  one  centre,  the  passage  of  the  dis- 
charge through  channels,  and  the  discharge  of  a  second 
centre,  it  follows  that  whenever  the  first  centre  discharges 
again,  there  is  a  tendency  for  the  discharge  of  the  second 
centre  again  to  follow  ;  and  this  tendency  is  strong  in  pro- 
portion to  the  strength  of  the  original   discharge   between 


THE   MIND.  73 

centre  and  centre,  and  to  the  number  of  times  the  discharge 
has  passed  from  one  to  the  other.  Or  if,  instead  of  regarding 
the  bodily  process,  we  look  to  the  mental  accompaniment, 
the  statement  will  be,  that  when  one  state  of  mind  has 
been  connected  by  a  relation  with  another  state,  then,  when- 
ever the  first  state  recurs,  there  will  be  a  tendency  for  the 
second  state  to  follow  it  in  similar  relation  ;  and  this  ten- 
dency will  be  strong  in  proportion  to  the  vividness  of  the 
consciousness  on  its  first  occurrence,  and  to  the  number  of 
times  that  the  succession  has  been  repeated.  This  tendency 
of  states  of  consciousness,  previously  associated,  to  follow  one 
another  again,  is  what  is  known  as  the  Law  of  Association, 
which  has  many  important  implications.  It  is,  as  is  evident, 
merely  the  law  of  memory  stated  over  again,  but  stated  in 
this  way  it  leads  us  to  conclusions  which  would  have  been 
less  readily  reached  from  the  former  basis. 

Whenever  the  occurrence  of  one  state  of  mind  drags  after 
it  into  consciousness  another  state,  in  the  relation  in  which 
they  have  previously  occurred,  there  is  a  remembrance,  a 
case  of  memory  ;  but  in  some  such  cases  we  give  another 
name  to  the  process.  Outside  the  window  at  which  I  am 
writing  there  is  a  spray  of  foliage  dancing  in  the  sunshine. 
The  sight  of  it — the  appearance  of  the  leaves  and  the  aerial 
roots  that  bristle  along  the  stem — produces  in  me  a  definite 
state  of  consciousness,  and  this  state  is  instantly  followed  by 
the  idea  of  the  sound  "  ivy,"  with  which  it  has  so  often  been 
connected  before.  I  remember  instantly  that  the  name  of 
the  plant  is  "  ivy."  But  I  do  not  call  it  a  remembrance.  I 
say  that  I  "  perceive  "  that  the  spray  is  a  spray  of  ivy.  Yet 
if  we  consider  we  shall  see  that  to  perceive  that  the  spray  is 
ivy  implies  much  more  than  merely  to  remember  that  its 
name,  is  ivy.  For  when  we  remember  the  name,  there  is 
so  far  an  end  to  the  mental  process  ;  but  when  we  perceive 
that  the  plant  is  ivy,  we  imply  that  it  has  all  the  qualities 
and  attributes  that  we  have  found  by  experience  that  other 
pieces  of  ivy  possess.  We  imply  that  it  has  the  power  of 
attaching  itself  by  its  aerial  roots,  that  it  is  evergreen,  that 


74  SANITY   AND   INSANITY. 

it  has  flowers  and  fruit  of  certain  appearance,  that  it  has  a 
certain  smell,  taste,  and  manner  of  growth.  The  attribution 
of  all  these  qualities  to  the  spray  before  us  are  all  so  many 
remembrances  of  previous  experiences  of  plants  of  similar 
appearance  ;  and  we  call  the  recollection,  in  a  more  or  less 
definite  and  vivid  manner,  of  all  these  various  attributes, 
coupled  with  the  appearance  of  the  spray  before  us,  the 
"  perception  "  that  the  spray  is  a  branch  of  ivy.  If,  however, 
I  take  my  eyes  off  the  spray  and  begin  to  write  a  description 
of  its  shining,  pointed  leaves,  its  appearance,  and  its  other 
qualities,  I  no  longer  call  my  consciousness  of  all  these 
qualities,  even  though  the  qualities  are  in  every  respect 
identical  with  those  I  thought  of  before,  a  "  perception  "  of 
the  ivy.  I  say  now  that  I  remember.  I  am  writing  the 
description  from  memory.  Wherein,  then,  lies  the  difference 
between  the  percept  and  the  remembrance  ?  Clearly  it  lies 
in  the  fact  that,  in  the  case  of  the  remembrance,  all  the  states 
of  consciousness  answering  to  the  attributes  of  the  plant  are 
of  the  dim,  faint,  inconspicuous  order.  In  the  case  of  the 
percept,  some  of  them  were  of  the  vivid,  bright,  conspicuous 
order  of  feelings  that  we  get  when  an  object  is  actually 
presented  to  our  senses,  and  which  are  therefore  called 
"  presentative  "  feelings.  The  difference  between  a  percept 
and  a  remembrance  is,  therefore,  that  in  the  former  a 
remembered  feeling,  or  a  group  of  remembered  feelings, 
follows  a  feeling  or  group  of  feelings,  some  of  which 
are  actually  presented,  and  follows  them  in  consequence  of 
having  previously  been  related  to  them,  either  in  their  faint 
or  their  vivid  forms  ;  while  in  the  case  of  the  memory,  both 
terms  consist  exclusively  of  faint,  remembered,  or  repre- 
sentative feelings.  In  the  percept  the  form  of  consciousness 
is  (f..f )  R  (/^/2./3..  &c.).  In  the  memory  the  form  is  (//) 
R  (/^/=./3..  &c.). 

Such  being  the  nature  of  perception  and  of  memory,  it 
remains  to  show  the  nature  of  reasoning,  the  third  form 
of  thought.  It  has  already  been  shown  how  large  a  part 
memory  plays  in   the  formation  of  judgments,  but  for  all 


THE    MIND.  75 

that,  judgment  or  reasoning  forms  a  faculty  of  mind  very 
distinct  from  memory  and  perception.  The  difference  is,  that 
while  in  memory  and  in  perception  the  process  is  a  revival 
in  consciousness  of  a  relation  that  has  been  established  pre- 
viously, in  reasoning  two  terms  are  brought  together  for  the 
first  time,  and  a  new  relation  is  established.  Thus,  as  I 
watch  the  spray  of  ivy  swaying  up  and  down  in  the  wind, 
I  am  impressed  by  its  flexibility.  I  remember  from  previous 
experience  its  toughness,  and  the  idea  occurs  to  me  that  it 
may  be  used  as  a  withy  to  bind  up  bundles  of  sticks.  Here 
is  a  process  of  reasoning.  The  display  of  flexibility  that  I 
see  in  the  ivy,  and  the  toughness  that  the  flexibility  drags  after 
it  into  my  consciousness,  are  combined  and  brought  newly 
into  relation  with  the  memory  of  a  need,  which  impressed 
me  yesterday,  for  some  substance  possessing  flexibility  and 
toughness.  The  two  states  of  mind  had  never  been  ap- 
proximated before.  Now,  for  the  first  time,  I  become  aware 
that  (the  qualities  of  this  spray)  are  like  (the  qualities  of  a 
withy),  and  the  idea  of  using  it  as  a  withy  arises  in  the  mind. 
This  assimilation  of  the  qualities  of  the  spray  to  those  of  a 
withy  is  neither  a  memory  nor  a  percept.  It  is  a  judgment, 
an  act  of  reasoning,  and  its  differentia  from  memories  and 
percepts  lies  in  the  fact  that  the  two  terms  are  newly  brought 
into  relation.  The  likeness  of  the  qualities  has  never  been 
noticed  before,  and  the  establishment  of  this  relation  of  like- 
ness is  a  ratiocination.  Both  in  memory  and  in  perception 
there  is  merely  the  revival  of  a  relation  previously  estab- 
lished. Whether  I  am  looking  at  the  spray  when  I  form 
the  opinion,  or  whether  the  remembered  flexibility  and 
toughness  of  the  spray  arouse  the  remembrance  of  similar 
qualities  in  the  withy,  does  not  affect  the  form  of  the  mental 
process.  It  is  obvious  that  whether  one  or  both  terms  of 
the  relation  are  presented  to  the  senses,  or  whether  both 
are  remembered,  makes  no  difference  to  the  novelty  of  the 
relation,  which  is  the  circumstance  that  determines  its 
nature  as  a  ratiocination.  Every  process  of  reasoning  is  the 
same  in  form — is  the  establishment  of  a  new  relation — and 


76  SANITY   AND   INSANITY. 

the  difference  between  different  judgments  depends  first 
on  the  complexity  of,  or  the  number  of  memories  in,  the 
two  terms  that  are  thus  newly  brought  into  relation  ;  and 
secondly,  on  the  degree  of  novelty  of  the  relation. 

That  the  process  of  reasoning  advances  with  the  com- 
plexity of  the  terms  united,  needs  but  little  insistence.  To 
conclude  that  the  properties  of  ivy  are  appropriate  to  fit  it 
for  a  binding  material  is  a  less  elaborate  judgment  than  to 
conclude  that  the  qualities  of  a  certain  man  will  fit  him  to 
hold  a  certain  position  ;  and  it  is  less  elaborate  because  the 
qualities  needed  in  a  binding  material  are  few  and  simple, 
and  the  terms  of  the  new  relation,  which  consist  of  a  con- 
sciousness, presented  or  remembered,  of  these  few  and  simple 
qualities,  are  likewise  simple.  But  the  qualities  necessary  to 
fit  a  man  for  a  certain  position  are  many  and  complex,  and 
the  state  of  consciousness  in  which  these  many  and  complex 
qualities  are  imagined,  and  inferred,  and  remembered,  and 
brought  into  proximity,  is  likewise  complex.  To  conclude 
that  an  expedition  composed  of  many  men  and  animals  will 
be  successful,  is  to  bring  into  a  precisely  similar  relation 
a  pair  of  terms,  each  of  which  is  very  far  more  complex  ;  and 
the  judgment  formed  is  still  more  elaborate. 

The  novelty  of  the  new  relation  is  a  far  more  important 
element  in  the  constitution  of  the  judgment  ;  on  it  de- 
pending the  originality  of  the  conclusion  that  is  formed. 
By  the  novelty  of  the  relation  is  meant  the  wideness  of 
separation  that  has  previously  existed  between  the  two 
terms  that  are  now  brought  together  ;  or,  to  put  it  other- 
wise, the  general  dissimilarity  of  the  things  that  are  now 
seen  to  be  alike,  or  the  general  similarity  of  the  things 
between  which  a  distinction  is  now  drawn. 

When  I  see  in  front  of  my  window  a  yew  tree  with  whose 
appearance  I  am  familiar,  and  recognize  it  as  the  yew  tree 
that  I  have  so  often  seen  before,  the  process  of  recognition 
is  a  process  of  remembrance,  as  has  already  been  explained. 
The  same  appearance  that  was  before  presented  arouses  the 
memory  of  the  same    qualities   that    have    been   found    in 


THE    MIND.  77 

experience  associated  with  that  appearance.  At  the  same 
time  that  I  recognize  the  familiar  appearance  of  the  tree 
in  its  accustomed  place,  I  notice  that  it  is,  in  horticultural 
phrase,  "  breaking  " — that  the  new  branches  and  young  leaves 
are  beginning  to  start  from  the  buds.  The  tree  is  therefore 
not  precisely  the  same — does  not  present  precisely  the  same 
appearance  as  formerly,  but  the  difference  is  so  trifling  that 
the  process  of  cognizing  it  to  be  the  same  tree  as  has  hitherto 
occupied  the  position  does  not  rise  to  the  level  of  a  judg- 
ment. It  is  still  a  percept,  although  the  first  term  in  the 
relation — (this  group  of  appearances)  is  like  (this  group  of 
remembrances) — contains  new  elements,  elements  of  dif- 
ference. The  terms  brought  together  in  this  relation  are, 
in  short,  not  precisely  the  same  as  the  terms  of  any  previous 
relation,  but  they  are  so  very  nearly  the  same — the  relation 
has  so  little  novelty — that  the  thought  is  called  a  percept 
or  remembrance,  and  not  a  judgment.  We  perceive  or 
remember  that  the  object  before  us  is  our  old  acquaintance  ; 
we  do  not  reason  that  it  is. 

In  my  walk  through  the  country  yesterday  I  came  across 
another  tree,  having  the  same  habit  of  growth,  form,  and 
colour  of  branch  and  leaf,  the  same  phyllotaxis,  the  same 
toughness  and  elasticity  of  bough  as  this  tree  with  which 
I  am  familiar.  The  familiar  appearances  aroused  at  once 
in  consciousness  the  familiar  name,  and  I  knew  it  was  a 
yew  tree.  Here  the  relation  in  the  mind  was  (the  appear- 
ance of  this  tree)  is  like  (the  remembrance  of  yew  trees). 
In  the  first  term  of  the  relation  there  was  a  good  deal  that 
was  novel.  I  had  never  seen  before  a  tree  having  precisely 
the  same  shape,  spreading  in  precisely  the  same  way, 
growing  to  precisely  the  same  height  and  breadth  ;  but 
these  elements  of  novelty  were  insignificant  beside  the 
familiar  elements — the  mode  of  branching  and  the  character 
of  the  trunk  and  leafage.  It  was  not  the  particular  shape, 
height,  and  mode  of  spread  that  aroused  in  me  the  con- 
sciousness that  it  was  a  yew  tree,  it  was  the  familiar  and 
more  general  qualities  ;  so  that,  although  the  first  term  of 


78  SANITY    AND    INSANITY. 

the  relation  contained  much  that  was  novel,  it  also  con- 
tained much  that  was  old  ;  and  it  was  the  old  elements, 
not  the  new,  that  conspicuously  entered  into  the  relation. 
Hence  the  thought  Avas  a  percept  or  memory,  and  not  a 
judgment.  It  was,  however,  less  obviously  a  percept  than 
the  previous  instance.  It  partook  more  of  the  nature  of 
reasoning,  and  less  of  the  nature  of  memory,  to  say  that  this 
tree,  which  I  have  never  seen  before,  is  a  certain  kind  of 
tree,  than  to  identify  this  other  tree  as  the  same  that  I  have 
for  long  been  familiar  with. 

Being  interested  in  trees,  I  notice,  as  I  go  round  my 
garden,  that  certain  characters  in  leafage  and  fruitage  of  the 
yew  are  similar  to  those  of  the  cedar,  the  fir,  the  cypress, 
and  other  trees,  and  the  whole  group  of  trees  exhibiting 
these  characters  are  associated  in  my  mind  as  members 
of  one  family  to  which  a  collective  name  may  be 
given.  In  this  case  the  dissimilarities  of  the  things  be- 
tween which  a  likeness  is  traced  are  much  more  numerous 
and  more  marked  than  in  the  previous  cases.  The 
differences  of  height,  of  size,  of  shape,  and  of  general  mode 
of  branching  are  very  great.  The  leafage  and  fruitage, 
which  are  the  appearances  assimilated,  are  by  no  means 
closely  similar.  Both  leaves  and  fruits  differ  in  size,  in 
colour,  in  surface,  in  shape,  in  consistence,  and  in  smell. 
The  leaves  are  alike  only  in  having  no  stalks,  being  long, 
narrow,  and  closely  set,  and  the  fruits  in  being  cones.  In 
this  case,  then,  in  which  likenesses  are  seen  among  things 
having  many  and  conspicuous  differences,  the  process  of 
thought  is  undoubtedly  a  judgment.  It  will  be  noticed  that 
while  the  differences  are  conspicuous  and  numerous,  the 
likenesses  are  widely  pervading. 

To  group  together  all  conifers  in  one  natural  order  is 
more  characteristically  a  judgment  than  to  group  together 
two  yews  as  trees  of  the  same  species,  because  the  establish- 
ment of  a  likeness  amongst  conifers  is  a  more  novel  process 
than  the  establishment  of  a  likeness  between  two  yews  ; 
and  the  process  is  more  novel  because  the  likeness  between 


THE    MIND.  79 

the  several  conifers  was  less  conspicuous  than  that  between 
the  two  yews,  and  the  differences  more  marked.  So  that, 
as  before  said,  the  elevation  of  the  reasoning  depends  on  its 
novelty,  that  is  on  the  number  and  conspicuousness  of  the 
differences  between  the  things  which  are  seen  to  be  alike, 
and  the  number  and  conspicuousness  of  the  resemblances 
between  the  things  which  are  seen  to  be  different. 

To  discriminate  between  a  healthy  person  and  a  sick  person 
does  not  require  a  very  powerful  effort  of  reasoning;  the  un- 
likeness  being  manifest,  patent,  and  unmistakable.  Among 
barbarous  people  there  is  no  discrimination  between  one 
illness  and  another.  If  a  man  is  ill,  he  is  ill.  The  degrees 
and  kinds  of  disability  which  the  illness  produces  are  not 
distinguished,  and  the  remedy  is  much  the  same  in  all 
cases.  With  the  increase  of  experience  and  knowledge 
it  becomes  recognized  that  there  is  more  than  one  way 
of  being  ill,  more  than  one  kind  of  illness.  It  is  seen  that 
while  all  cases  of  illness  are  alike  in  that  they  produce  dis- 
ability, there  are  some  illnesses  that  produce  total  disability 
for  exertion,  and  that  in  these  illnesses  the  patient's  skin 
is  hot  and  dry,  he  is  thirsty,  he  rapidly  wastes  away,  and 
his  progress  to  death  or  recovery  is  rapid.  This  discrimina- 
tion of  fever  from  other  illnesses  is  a  higher  effort  of 
reasoning  than  the  discrimination  of  sick  from  healthy 
people,  and  it  is  higher  because  the  things  perceived  to  be 
different  are  less  conspicuously  unlike.  As  time  goes  on, 
and  the  study  of  disease  progresses,  it  is  noticed  that  in  some 
cases  fever  is  preceded  by  a  wound  or  injury,  while  in 
others  there  is  no  such  antecedent.  Hence  the  division 
of  fevers  into  traumatic  and  idiopathic.  Observation  of 
idiopathic  fevers  shows  that  some  of  them  are  accompanied 
by  the  appearance  of  a  rash  on  the  skin,  while  others  are 
not.  This  further  discrimination  of  difference  between 
things  generally  alike  is  a  further  advance  in  knowledge, 
and  is  achieved  by  an  effort  of  reasoning  which  is  of  higher 
character  than  that  required  in  the  previous  cases,  and  is 
higher  because  the  difference  perceived  is  less  conspicuous, 


8o  SANITY   AND   INSANITY. 

and  the  things  perceived  to  be  different  have  more  numerous 
points  of  resemblance.  The  separation  of  eruptive  fevers 
into  small-pox,  measles,  scarlatina,  typhus,  &c.,  is  a  still 
further  advance  of  the  same  process,  is  a  higher  effort 
of  reasoning,  and  owes  its  estimation  as  a  more  elevated 
process  to  the  same  circumstance.  Many  years  after  typhus 
fever  has  been  known  and  studied  some  cases  of  it  are  found 
to  have  a  somewhat  different  appearance,  and  to  run  a 
somewhat  different  course  from  others.  A  long  course  of 
observation  establishes  the  fact  that  under  the  name  of 
typhus  fever  have  been  included  two  different  maladies, 
having  different  courses,  symptoms,  and  lesions,  and  hence 
arises  the  division  into  typhus  and  typhoid,  a  still  higher 
example  of  reasoning  power  ;  and  finally,  further  study  has 
discriminated  several  varieties  of  typhoid  fever — abortive 
typhoid,  aj^bulatory  typhoid,  typhoid  with  meningitis,  and 
so  forth.  In  each  of  these  cases  the  advance  of  knowledge 
from  the  simple  recognition  of  the  broadest,  most  con- 
spicuous difference  between  health  and  illness  to  the  fine 
distinctions  between  different  varieties  of  a  highly  special 
malady,  has  been  by  discrimination — by  the  discernment 
of  differences  between  things  at  first  sight  alike — by  esta- 
blishing a  new  relation  (of  unlikeness)  between  things  here- 
tofore grouped  together  as  alike.  And  at  each  step  the 
display  of  intelligence — the  quality  of  the  reasoning — has 
been  considered  superior,  according  as  the  similarities 
between  the  things  seen  to  be  different  are  numerous,  con- 
spicuous, and  close. 

In  practice,  the  two  processes  of  discerning  likenesses  and 
discriminating  differences  are  not  carried  on  separately.  It 
is  obvious  that  in  grouping  together  the  coniferse  as  having 
certain  qualities  of  leafage  and  fruitage  in  common,  we  at  the 
same  time  separate  them  as  a  group  from  the  remaining 
bulk  of  trees  and  shrubs.  If  all  plants  had  these  peculiarities, 
it  would  not  occur  to  us  to  separate  the  few  that  have  been 
enumerated,  and  there  would  be  no  basis  for  such  separation. 
At  the  same  time  that  we  group  all  conifers  together  because 


THE    MIND.  8 1 

of  their  underlying  likenesses  pervading  throughout  con- 
spicuous differences,  we  separate  them  from  all  other  shrubs 
and  trees  because  of  their  underlying  differences  of  fruit  and 
leaf  prevailing  in  spite  of  the  conspicuous  similarities  of 
height,  size,  shape,  mode  of  growth,  branching,  &c. 

Similarly,  in  dividing  traumatic  from  idiopathic  fevers,  we 
are  aware,  not  only  of  the  difference  betw^een  cases  of  the  one 
and  cases  of  the  other,  but  at  the  same  time  we  are  impressed 
with  the  fact  that  all  cases  of  traumatic  fever  resemble  one 
another  in  being  preceded  by  wounds,  while  all  cases  of  idio- 
pathic fever  resemble  one  another  in  having  no  such  ante- 
cedent.    The  same  rule  holds   in  every  case.     We  cannot 
discern  similarities  without  at  the  same  time  being  aware 
of    differences,   nor  trace   differences    without   noting  simi- 
larities.    The  whole  process  of  thought  is  a  rhythm  between 
the  two  attitudes.      Each  is  complementary  of  the  other. 
In  each  the  reasoning  becomes  more  refined  the  more  com- 
plex the  aggregate  of  things  between  which  the  relation  of 
likeness  or  unlikeness  is  traced  ;  and  in  each  the  grade  of 
reasoning  rises  with  the  novelty  of  the  new  relation.     It  is 
higher  the  more  numerous,  the  more  conspicuous,  the  more 
various   are  the  differences  between   the  things  seen  to  be 
similar,  and  it  is  higher  the  more  close,  the  more  striking, 
and  the  more  multitudinous  the  likenesses  among  things  seen 
to  be  different. 

Although  the  two  processes  thus  proceed  together  in  per- 
petual alternation,  yet  they  are  not  often  equally  developed 
in  the  same  person.  The  power  of  discerning  a  fundamental 
likeness  between  things  superficially  different  is  by  no  means 
always  proportioned  to  the  power  of  discerning  differences 
between  things  superficially  alike,  and,  according  as  the  one 
or  the  other  preponderates,  the  cast  of  the  mind  differs.  If  we 
study  the  likeness  between  this  plant  and  that,  and  by  means 
of  likenesses  group  the  plants  together  into  species,  genera, 
orders,  families,  &c.,  the  process  is  synthetic.  If,  on  the 
other  hand,  we  begin  with  plants  as  a  whole  and  divide  them 
by  discerning  their  differences,  the  process  is  one  of  analysis. 

7 


82  SANITY   AND   INSANITY. 

In   practice,  as  has   been  seen,  the  grouping  of  things  and 
their  division  naturally  proceed  simultaneously  ;   but   none 
the    less    is    it   true  that  the    leading  characteristic  of  the 
S3^nthetic    mind    is  the  faculty  of    discerning    fundamental 
similarities    underlying   conspicuous   differences,    while   the 
distinguishing  faculty  of  the  analytic   mind   is  that  of  per- 
ceiving fine  shades  of  difference  in  things  generally  similar. 
It  is  obvious  from   what  has  been   said,  that   the  leading 
trait  in  the  scientific  mind  is  the  discernment  of  differences. 
To    take    an    instance.     The    observation    of    the   apparent 
diurnal  movement  of  the  sun  round  the  earth,  is  the  obser- 
vation of  differences  of  position  of  the  sun  with  respect  to 
the  earth  ;  and  similarly  that  of  the  annual  movement  of  the 
sun  among  the  stars  is  the  observation  of  smaller  differences 
of  position.     The  next  advance  of  knowledge  is  the  obser- 
vation that  these  differences  of  position  are  assumed  with 
different  velocities  ;  and  the  next,  that   these   differences  of 
velocity  are  accompanied  by  differences  in  the  apparent  size 
of  the  sun  ;  from  the  likeness  of  which  to  similar  cases  of 
moving  bodies  whose  distance  we  can  measure,  it  is  concluded 
that  at  different  times  the  sun  is  at  different  distances  from 
us.     Hence  the  inference  of  the  ellipticity  of  the  apparent 
movement  of  the  sun,  that  is,  of  the  earth's  orbit.     Next  it 
is  observed  that  the  variation,  or  range   of  difference  of  the 
apparent  velocity  is  different  from  the  variation  of  the  dis- 
tances.    Here,  then,  is  observed  a  difference  between   diffe- 
rences, and  thence  we  conclude  an  actual  variation  in  the 
velocity  of   the    sun's   movement.      In    the    same   way  the 
observed  difference  in  longitude  from  time  to  time   of  the 
whole  body  of  stars  shows  us  the  precession  of  the  equinoxes, 
and  a  still  finer  difference  in  longitude   and   right  ascension 
of  the  stars,  occurring  over  shorter  periods,  demonstrates  the 
occurrence  of  nutation.     The  whole  advance  in  knowledge 
is  a   succession   of  discriminations   of   difference,   with  here 
and   there   a   tracing   of  resemblance.     The  fact  that  some 
plants  stand  upright  by  their  own   sturdiness,  while  others 
are  dependent  on  extraneous  aid  for  their  support,  is  apparent 


THE    MIND.  83 

to  the  most  ordinary  observer.  A  gardener,  from  closer 
observation,  knows  that  of  the  latter  class  some  support 
themselves  by  means  of  tendrils,  while  others,  without  that 
special  means  of  prehension,  gain  support  by  twining  their 
stems  and  branches  among  trees  of  more  robust  growth. 
Botanists  know  that  of  tendrils  there  are  many  kinds,  some 
being  furnished  with  suckers  to  stick  to  their  supporters, 
others  with  hooks  to  cling,  while  others  again  depend  for  a 
fast  hold  merely  upon  their  power  of  twisting  on  themselves. 
Again,  some  tendrils  are  modified  leaves,  others  are  modified 
stipules,  others  modified  parts  of  leaves,  others  modified 
branches,  others  modified  flower  peduncles.  In  every  in- 
stance the  discovery  of  the  origin  of  the  tendril  marked  an 
advance  in  knowledge  and  was  the  observation  of  a  new 
difference.  The  one  quality  before  all  others  which  science 
demands,  which  is  characteristic  of  all  scientific  work,  and 
which  advances  with  the  advance  of  science,  is  exactness  ; 
and  exactness  is  nothing  but  the  discrimination  and  exclu- 
sion of  small  differences.  The  farmer  who  weighs  his  cattle 
on  a  weigh-bridge  and  sells  by  actual  weight  is  more  scien- 
tific than  he  who  guesses  at  their  weight  by  their  apppearance  ; 
and  he  is  more  scientific  because  more  exact,  because  the 
possible  error  is  less,  because  the  difference  between  the 
estimated  weight  and  the  actual  weight  is  smaller.  From 
the  weigh-bridge,  which  discriminates  only  between  pounds, 
to  the  chemical  balance  which  discriminates  between  minute 
fractions  of  a  grain,  the  advance  is  continuous,  and  he  is 
deemed  the  more  scientific  who  deals  with  the  finest  diffe- 
rences. Weighing  and  measuring  are  at  the  root  of  all 
science  ;  and  weighing  and  measuring  are  but  means  of 
discrimination  of  differences  between  weights  and  sizes.  No 
branch  of  knowledge  is  entitled  to  be  called  a  science  until 
means  have  been  devised  of  measuring  its  subject-matter,  and 
every  advance  in  the  science  is  an  advance  in  accuracy  of 
measurement.  The  invention  of  the  thermometer  was  the 
foundation  of  the  science  of  thermology,  and  every  advance 
in  the  science  has  depended  on  an  improvement  in  thermo- 


84  SANITY   AND   INSANITY. 

metrics.  Not  until  means  of  measuring  the  volume  and 
intensity  of  electric  currents  had  been  devised,  did  electricity 
advance  from  the  position  of  a  toy  to  be  the  subject-matter 
of  a  science.  The  difference  between  the  rude  estimates  of 
the  ordinary  mechanic  and  the  scientific  calculations  of  the 
engineer,  are  represented  by  the  difference  between  the  two- 
foot  rule  of  the  one,  and  the  complicated  machine  by  which 
the  other  measures  differences  of  one  two-millionth  of  an 
inch. 

While  the  observation  of  the  facts  of  science  is  for  the 
most  part  a  discrimination  of  differences,  the  organization 
of  these  facts  into  knowledge  is,  for  the  most  part,  an  assimi- 
lation of  resemblances.  That  the  difference  in  velocity  of 
the  sun's  apparent  movement  is  accompanied  by  differences 
in  its  apparent  size,  is  a  fact  of  observation  and  a  discrimi- 
nation of  differences  ;  but  the  inference  that  the  sun  moves 
at  different  distances  from  us,  is  an  assimilation  of  this  group 
of  differences  to  other  like  groups  of  phenomena  in  which 
the  distances  have  been  found  to  be  diff'erent  ;  as,  for 
instance,  to  the  case  that  when  a  man's  apparent  size  is 
great  and  his  rate  of  movement  across  the  field  of  vision 
rapid,  he  is  nearer  to  us  than  when  his  apparent  size  is  less 
and  his  speed  across  the  field  of  vision  slower.  Similarly, 
the  description  of  the  various  forms,  textures,  surfaces,  and 
mode  of  growth  of  leaves  are  facts  of  observation,  and  are 
discriminations  of  difference  ;  while  the  recognition  of  whorls 
of  leaves  in  the  parts  of  the  flower,  is  an  assimilation  of 
resemblances. 

Just  as  the  leading  feature  in  the  scientific  mind  is  its 
intellectual  keenness,  shown  by  the  ability  to  discriminate 
differences,  so  the  leading  feature  in  the  mind  of  the  poet 
is  not  its  intellectual  power,  but  the  volume,  the  profundity, 
the  vastness  of  the  feelings  by  which  it  is  agitated.  Feelings 
of  this  character,  powerful  though  they  be,  are  in  their 
nature  vague,  formless,  and  indefinite  ;  and  hence  poetic 
writings  are  rich  in  power  and  poor  in  precision.  What 
purely  intellectual,  as  distinguished  from  emotional,  power 


THE    MIND.  85 

the  poet  possesses,  is  antithetical  in  nature  to  that  of  the 
man  of  science.  It  is  not  the  abihty  to  perceive  diiferences 
between  things  that  are  superficially  similar,  but  the  ability 
to  perceive  resemblances  between  things  apparently  unlike. 
It  was  Goethe,  a  poet,  it  will  be  remembered,  who  perceived 
the  similarity  of  the  bones  of  the  skull  to  the  vertebrae,  and 
of  the  petals  of  the  flower  to  leaves,  and  thus  cast  a  new 
light  upon  morphology.  Here  the  things  between  which  a 
resemblance  had  to  be  perceived  were  so  widely  different 
that  the  ordinary  scientific  mind  was  unequal  to  the  task, 
and  the  poetic  faculty  was  needed  for  its  accomplishment. 
If  we  seek  to  identify  the  special  quality  in  poetic  writing 
which  most  widely  distinguishes  it  from  prose,  it  will  be 
found  in  the  abundant  use  of  simile  and  metaphor — that  is 
to  say,  in  the  abundant  likenesses  that  are  traced  between 
things  superficially  and  widely  different.  The  poetic  fancy 
is  nothing  but  this  faculty  of  seeing  likenesses  between 
widely  different  things. 

It  still  remains  to  examine  the  nature  of  Will — a  knotty 
problem  which  has  given  rise  to  innumerable  and  bitter 
controversies.  By  Will  is  meant  the  feeling  that  precedes 
action.  To  recur  to  a  former  illustration,  I  may  think  of 
moving  my  hand  in  a  certain  w^ay,  or  I  may  actually  so 
move  it.  In  the  former  case  there  is,  as  we  have  already 
seen,  a  faint  excitation  or  discharge  of  the  same  region  that 
in  the  latter  case  discharges  more  strongly.  In  the  former 
case  I  think  of  moving  the  hand,  in  the  latter  I  Will  to 
move  it,  and  it  moves.  It  is  evident  that  since  the  nervous 
processes  differ  in  nothing  but  intensity,  the  mental  pro- 
cesses can  differ  in  nothing  but  intensity,  and  hence  to  will 
a  movement  is  to  think  very  intensely  of  that  movement. 
Proofs  of  this  proposition  are  found  in  the  phenomena  of 
muscle-reading.  The  muscle-reader  is  able  to  discover 
movements  thought  of  by  the  subject  ;  and  he  discovers 
them  by  holding  the  hand  of  the  subject — by  observing 
trifling  movements  or  stresses,  ?>.,  tendencies  to  movement,  of 
hand,  arm,  and  fingers.     So  that  when  we  think  of  moving, 


86  SANITY   AND    INSANITY. 

which  is  an  incipient  form  of  wilHng  movement,  we  actually 
do   excite  in   incipient  form   the   movements   we   think  of. 
Add  to  the  intensity  of  the  nerv^ous  process,  and  the  move- 
ment,  from  being  incipient,  becomes   actual  ;    the    mental 
accompaniment,  from  being  a  thought,  becomes  a  volition. 
The  volition  appears,  it  is  true,  not  to  accompany,  but  to 
precede  the  movement  ;  and  actually  does  precede  it  by  a 
short  time — by  the  time  necessary  for  the  nervous  discharge 
to  travel  from  the  centre  of  whose  activity  the  volition  is 
the  mental  shadow,  to  the  muscles  whose  activity  appears  to 
be    a    consequence   of   the  volition.      But   the  feeling  that 
immediately  precedes   a  bodily  movement  is  not  the  only 
feeling  that  we  call  a  volition.     We  give  the  same  title  to 
the    process    of    "  making    up    the  mind "   to  pursue  some 
prolonged   and   complicated   course   of    action.     When,  for 
instance,  we  finally  decide  to  bring  an  action  at  law,  we  say 
we  Will  do  it  ;  and  we  recognize  the  decision  as  a  volition, 
although  it  does  not  immediately  precede  action — although, 
for  instance,  we  may  not  write  the  letter  of  instructions  to 
the  solicitor  for  days.     In  order  to  discover  the  community 
of   nature    between   this    process    and   the    simpler  case  of 
moving  the  arm,  we  must  recall  the  nature   of  the  nervous 
processes   on  which  they  severally  depend.     When  I  deter- 
mine or  Will  to   move  my  arm,  what  is  the  nature  of  the 
nervous  process  ?     We  have  already  seen  that  it  is  the  dis- 
charge of  a  nervous  centre,  but  we  must  go  behind  this  and 
ask  why  it  is  this  particular  centre  that  now  discharges.  The 
answer  is  that  there  is  impressed  upon  the  organism  from 
without,  in   the  way  already  shown,  the  need  for  activity  ; 
and  this  impression  arouses  general  nascent   activity  of  the 
whole  nervous  system.     The   impress  is   more  specific.     It 
calls  for  activity  of  the  arm  ;    and  throughout  the   whole 
region  of  grey  matter  in  which  movements  of  the  arm  are 
represented,  the  nascent   activity  is  intensified.     Now,  but 
one  movement  of  the  arm  can  take  place  at  a  time.     Among 
these  nascent  activities,  all  of  which  are  striving,  as  it  were, 
to   become    actual   and    to   produce  movement,   there  is    a 


THE    MIND. 


^7 


Struggle  for  preponderance  ; — a  struggle  which  is  evidenced 
outwardly  in  the  bracing  up  of  the  muscles  preparatory  to 
exertion.  At  length,  owing  to  the  nature  of  the  impression, 
and  to  the  direction  of  paths  previously  traversed  by  currents 
in  circumstances  somewhat  similar,  one  of  these  struggling 
centres  gains  the  preponderance.  The  fittest  survives  ;  the 
tension  among  the  bursting  centres  is  relieved  by  the  dis- 
charge of  one  of  them  ;  and  thus  the  nervous  accompani- 
ment of  volition  is  not  merely  a  discharge  of  a  single  centre, 
but  a  discharge  which  follows  a  struggle  for  preponderance, 
and  marks  the  triumph  of  one  of  the  conflicting  factors. 
Hence  this  feeling  arises  not  only  when  actual  movement 
follows  this  successful  struggle,  but  arises  also  in  a  somewhat 
modified  form  when  a  similar  struggle  takes  place  on  a  higher 
plane  of  nervous  action,  and  terminates  in  the  preponderance 
of  one  of  the  struggling  activities,  without  that  activity 
finding  immediate  expression.  In  other  words,  volition  or 
Willing  comes  to  be  the  feeling  Avhich  accompanies  the 
termination  of  a  struggle  among  nascent  activities  by  the 
preponderance  of  one,  just  as  Hesitation  is  the  feeling  that 
corresponds  with  the  duration  of  the  struggle. 

In  connection  with  the  Will,  the  vexed  question  of  Free- 
will must  be  touched  upon.  If  it  is  asked  whether  I  am 
free  to  do  this  thing,  the  first  question  manifestly  is.  What  is 
this  I,  that  is  free  or  not  free  ?  What,  in  other  words,  is 
the  nature  of  the  conscious  ego  ?  We  have  already  seen 
that  consciousness  accompanies  the  activity  of  nervous  pro- 
cesses ;  that  the  newer  processes  are  accompanied  by  more 
vivid  consciousness,  the  older  by  less  vivid  consciousness, 
and  the  oldest  by  no  consciousness  at  all.  The  scene  of 
greatest  activity  among  our  nervous  processes  is  continually 
shifting  from  one  centre  to  another,  and  from  one  region  to 
another  ;  and,  correspondingly,  our  consciousness  is  con- 
tinually changing.  We  have  from  moment  to  moment  a 
succession  of  thoughts  and  feelings.  As  the  brain  becomes 
modified  by  use,  growing  in  one  direction  and  perhaps 
wasting  in  another  ;  as  new  channels  are  opened,  new  con- 


88  SANITY    AND    INSANITY. 

nections  made,  new  centres  erected,  in  some  regions  ;  while 
in  other  regions  disused  channels  are  closing  and  disused 
centres  decaying  ;  so,  day  by  day  and  year  by  year,  the  general 
scope  and  locality  of  the  greatest  nervous  activity  alters, 
and  so,  day  by  day  and  year  by  year,  the  general  conscious- 
ness changes,  and  we  find  that  we  no  longer  feel  and  think 
as  we  used.  New  interests  are  aroused,  new  pursuits 
followed,  new  thoughts  absorb  us,  while  old  ones  fade  and 
disappear.  Throughout  all  changes,  however,  we  feel  that 
something  has  persisted.  Although  I  have  changed,  I  still 
feel  that  throughout  there  has  been  an  "I,"  and  the  same 
"  I  "  has  been  changing — that  there  has  been  throughout  a 
substratum  which  has  not  changed  or  has  changed  but  little. 
A  fortiori^  throughout  the  changing  consciousness  of  a  day, 
through  all  the  succession  of  different  thoughts,  feelings, 
and  volitions,  there  has  been  a  persistent  somewhat  that 
has  thought,  felt,  and  willed.  Although  the  procession  of 
figures,  of  pictures,  of  shadows,  across  the  screen  of  con- 
sciousness has  been  incessantly  changing,  the  screen  has 
remained  throughout,  inconspicuous  but  essential.  If,  then, 
our  conscious  personality  at  any  moment  is  but  the  sum  of 
all  the  states  of  consciousness,  of  all  the  thoughts  and  feelings, 
vivid  and  faint,  that  exist  at  that  moment,  what  are  the 
states  that  thus  persist  ? 

The  ansAver  to  this  is  as  follows.  Our  consciousness,  our 
*'  self-consciousness,"  our  "  conscious  personality,"  our  "  ego" 
at  any  moment  is  but  the  sum  of  all  our  thoughts  and  feelings, 
vivid  and  faint,  at  that  moment.  But  these  co-existent  states 
of  consciousness  are  very  numerous  and  complicated.  The 
nervous  processes,  of  which  they  are  the  mental  shadow, 
are  kept  in  activity  by  the  continuous  arrival  of  currents 
from  without,  and  respond  by  continuous  discharges  that 
escape  outward.  Now,  when  a  current  arrives  from  without, 
the  discharge  of  the  tract  that  receives  it  has  a  mental 
accompaniment.  And  when  a  current  escapes  outwards  the 
discharge  of  the  tract  that  emits  it  has  a  mental  accompani- 
ment.     Thus  are  we  kept  aware  of  what  is  acting  on  us  and 


THE    MIND.  ^9 

of  the  ways  in  which  we  are  reacting.  But  in  addition  to 
this  continual  flux  and  reflux  of  currents  to  and  from  the  out- 
side Avorld,  there  is,  as  we  have  seen,  another  tide,  an 
internal  circulation  of  energy,  Avhich  also  contributes  to  the 
general  activity  of  the  nervous  centres.  Not  only  through 
the  sense  organs  do  we  receive  impacts  of  energy  from  the 
outside  world,  but  from  every  part  of  our  own  bodies 
currents  are  continually  flowing  into  the  central  reservoirs  of 
the  nervous  system  ;  and  from  all  the  nervous  regions,  from 
the  highest  to  the  lowest,  discharges  are  continually  being 
distributed  to  every  recess,  nook,  and  corner  of  our  own 
organization. 

What  is  true  of  the  apparatus  which  keeps  us  in  com- 
munication with  the  outside  world  is  true  also  of  this  interior 
apparatus  of  energy-distribution.  Every  wave  of  energy 
that  arrives  from  the  viscera,  the  muscles,  or  any  part  of  the 
interior  of  the  body,  and  washes  on  the  shore  of  the  central 
nervous  masses,  produces  there  a  discharge,  which  has,  vivid 
or  faint,  some  mental  accompaniment.  And  every  discharge 
that  starts  from  the  great  nervous  centres  to  be  distributed 
in  the  interior  of  the  body  has  also,  vivid  or  faint,  its  mental 
shadow.  Hence  is  consciousness  composed  not  only  of  feel- 
ings and  thoughts  referring  to  the  outside  world,  but  beneath 
these  there  is  a  vast  body  of  other  feelings  and  other  thoughts 
referring  to  what  is  going  on  in  the  interior  of  our  own 
organism.  Now,  from  the  nature  of  things  it  will  appear 
that  since  the  internal  bodily  processes  are,  as  a  rule,  same 
and  continually  repeated,  the  mental  accompaniment  will, 
from  the  laws  already  investigated,  as  a  rule  be  faint  and 
inconspicuous.  But  since  the  currents  arriving  from  the 
interior  of  the  body  are  continuous  and  same,  they  will  tend 
to  modify  continuously,  and  in  the  same  direction,  the  other 
currents  arriving  from  without  the  body ;  and  hence  on  them 
will  depend  what  we  term  the  "  disposition "  of  the  in- 
dividual. Since  the  currents  thus  internally  initiated  and 
internally  distributed  are  of  enormous  volume,  their  poten- 
tiality of  altering  the  other  currents  will  be  great  ;  and  when 


90  SANITY    AND    INSANITY. 

disordered,  their  effect  will  be  very  important.  It  is 
notorious  that  although  in  health  we  are  unconscious  of  the 
action  of,  for  instance,  the  stomach,  yet  the  way  in  which 
that  organ  performs  its  functions  makes  all  the  difference  to 
us  of  happiness  or  misery.  Lastly,  since  these  currents  are 
continuous,  whatever  consciousness  they  have  as  their 
accompaniment  will  be  continuous,  hoAvever  subdued,  how- 
ever inconspicuous,  however  eclipsed  by  the  more  vivid  and 
definite  consciousness  arising  from  commerce  with  the  outside 
world.  Moreover,  while  the  definite,  vivid  consciousnesses 
arising  from  commerce  with  externals  is  continually  changing, 
and  changing  through  a  very  wide  range  of  variation,  that 
w^hich  arises  from  the  internal  circulation  is  subject  normally 
to  changes  which  are  few,  which  are  slow,  and  which  are 
slight,  and  thus,  so  far  as  consciousness  can  be,  it  is  from 
moment  to  moment  unchanging.  It  is  little  liable  to  change. 
It  is  a  rhythmical  succession  of  slow  and  slight  changes  of  a 
process  which  is  itself  voluminous  and  vast.  Hence  the 
consciousness,  while  faint,  is  continuous  and  is  voluminous. 
And  it  is  always  present.  The  feelings  of  sight  disappear 
when  we  shut  our  eyes.  Often  we  receive  no  impression 
through  the  ears,  the  nose,  the  tongue.  But  the  currents 
from  within  our  own  body  are  always  arriving.  Waking  or 
sleeping  they  never  cease.  According  as  the  impressions 
arriving  from  without  are  numerous,  powerful,  and  definite, 
this  sub-consciousness,  this  coen^esthesis,  subsides  yet  more  into 
obscurity  and  is  forgotten  ;  but  when  the  avenues  of  sense  are 
closed,  or  when  we  are  in  darkness  and  in  silence  and  in  in- 
activity, then  emerge  into  a  less  obscure  twilight  these 
feelings  of  what  is  going  on  within  us,  this  consciousness  of 
our  bodily  operations.  Who  has  not  found,  when  lying 
wakeful  in  the  darkness  and  silence  of  night,  that  his  heart 
beats  with,  it  appears,  preternatural  vigour  ;  that  in  this  foot 
or  that  arm  there  are  sensations  which  must  surely  portend 
disease  ;  that  a  burning  here  or  a  chilliness  there  are  felt  with 
an  intensity  which  is  never  experienced  in  the  daytime  ? 
The  changes  of  these  processes,  though  slight,  will  still  be 


THE    MIND.  91 

sufficient  to  secure  that  some  consciousness  shall  attach  to 
their  working,  and  their  great  volume  will  secure  that  what- 
ever feelings  attach  to  their  operation,  shall  be,  if  not  vivid, 
voluminous  and  pervading. 

The  conscious  personality,  or  conscious  ego,  is,  then,  the 
sum  of  all  the  states  of  consciousness  at  one  time  existing, 
of  which  some — externally  initiated —  are  vivid,  definite,  for 
the  most  part  intense,  and  subject  to  frequent  and  sudden 
changes,  while  others — internally  initiated — are  faint,  indefi- 
nite and  voluminous,  and  change  slowly  and  seldom.  Hence 
it  comes  to  pass  that  the  former  series  of  changes  are 
regarded  as  imposed  upon  the  latter  as  figures  upon  a  back- 
ground ;  the  latter  are  looked  upon  as  the  permanent, 
persistent  being  of  which  the  former  are  changes.  When  a 
new  feeling  is  superposed  on  the  existing  mass  of  conscious- 
ness, as  when  I  hear  a  sudden  sound,  a  change  takes  place  in 
the  externally-connected  series  of  consciousness,  but  there 
is  no  corresponding  change  in  the  internally-connected  series. 
This  internally-connected  series,  bound  up  as  it  is  in 
experience  with  changes  in  my  body,  continuous  as  it  is,  and 
little  subject  to  change,  I  identify  in  an  especial  manner 
with  myself,  and  I  speak  of  the  conspicuous  change  in  the 
one  series,  superposed  on  the  unaltered  subordinate  series,  as 
a  change  occurring  to  me^  when  I  should  say  it  is  a  change 
occurring  in  me — in  my  consciousness.  Similarly,  when  an 
outgoing  current  is  discharged  from  a  superior  centre  and 
eventuates  in  a  movement,  there  is  a  change  in  the  definite 
conspicuous  series  of  consciousness,  with  no  considerable 
corresponding  change  in  the  more  fundamental  series,  and 
again  the  temporary  state  is  superposed  on  the  permanent 
state  which  is  specially  identified  with  the  ego,  and  I  say 
that  "I  willed"  the  movement,  that  the  volition  was 
effected  by  me,  when  I  should  say  that  it  occurred  in  me — 
in  my  consciousness.  In  other  words,  when  a  volition  is 
made,  there  is  a  change  in  consciousness.  The  whole 
complex  group  of  feelings  and  thoughts  changes  and  gives 
way  to  another  group.    Of  this  complexus  which  thus  changes. 


92  SANITY    AND    INSANITY. 

there  are  two  parts,  one  subordinate,  inconspicuous, 
voluminous,  and  pervading,  which  changes  Httle  ;  and  one 
prominent,  definite,  intense,  and  hmited,  which  changes 
much.  Hence  it  comes  to  be  considered  that  the  more 
enduring  portion  produces  the  change  in  the  more  transient  ; 
whereas  the  fact  is  that  the  change  is  the  product  of  conditions 
to  which  both  moieties  of  consciousness  are  subject.  It  is 
the  mental  shadow  of  a  change  of  nervous  processes,  a  change 
brought  about  in  the  way  already  indicated,  by  impressions 
arriving  from  both  sources,  acting  upon  a  specially  constituted 
structure,  and  liberating  energy  in  special  directions. 

The  totality  of  consciousness  is  then  made  up  of  two  parts — 
one  corresponding  with  impressions  made  by,  and  actions  made 
upon,  the  outside  world;  the  other  corresponding  with  currents 
arriving  from,  and  discharges  distributed  to,  the  interior  of  the 
body  itself.  The  former  constitutes  our  consciousness  of  the 
world  at  large,  the  latter  our  consciousness  of  self.  Or,  as 
sometimes  expressed,  the  former  is  object-consciousness,  the 
latter  is  subject-consciousness.'  Another  term  for  this  latter 
moiety  of  consciousness  is  the  ''coenaesthesis."  Whatever  it  is 
called,  the  inferior  moiety  of  consciousness  is  to  us  a  matter  of 
immense  importance,  since  it  is  the  seat  of  by  far  the  major 
portion  of  our  experiences  of  pleasure  and  pain. 

That  what  is  termed  "  bodily  pain" — that  is  to  say,  pain 
arising  from  some  actual  lesion  or  physical  injury  to  the 
body — is  the  mental  shadow  of  a  disturbance  in  the  central 
mass  of  grey  substance,  due  to  intense  currents  arriving 
through  the  nerves  from  the  injured  part,  does  not  need 
demonstration.  Apart  from  acute  pains,  there  are  the 
feelings  of  illness,  of  malaise,  of  langour,  of  misery,  which 
accompany  changes  of  injurious  character  that  are  wider 
spread  and  slower  in  their  operation — such  changes  as 
inflammations,  derangements  of  function,  &c.  All  such 
feelings    manifestly   belong   to  the  coenaesthesis,   and  being 

'  These  terms  are,  however,  used  also  in  a  very  different  sense — the  former, 
to  express  action  of  the  organism  on  the  environment ;  the  latter,  action  of 
the  environment  on  the  organism. 


THE    MIND.  93 

general  and  unlocalizcd  in  character,  they  stand  out  distinct 
from  the  "  pains  "  proper.  In  addition  to  these  general 
feelings  accompanying  general  disorder,  there  are  some 
which  are  more  specialized  according  to  the  part  affected. 
If  we  exclude  the  special  sense  organs,  the  skin  and  the 
muscles  and  bones,  whose  nervous  afflux  and  reflux  cor- 
responds with  changes  in  the  moiety  of  consciousness  with 
which  we  are  not  now  dealing,  there  remain,  roughly 
speaking,  but  four  groups  of  viscera  as  sources  and  receptacles 
of  the  nerve  currents  which  correspond  with  the  coenaesthesis. 
These  are  the  heart,  the  lungs,  the  digestive  organs,  and  the 
genito-urinary  organs  ;  and  a  morbid  change  occurring  in 
either  of  these  groups  imparts  a  special  character  to  the 
nervous  currents  proceeding  from  it,  and  is  attended  by  a 
special  modification  in  the  coenaesthesis.  Thus,  the  special 
alteration  of  consciousness  that  attends  disease  of  the  heart 
is  a  tendency  to  anxiety — to  active  terror.  When  the  lungs 
are  diseased  it  is  said  that  there  is  a  tendency  for  the  cast  of 
mind  to  become  joyous,  and  it  is  certain  that  the  apprehen- 
sion of  danger  and  sense  of  ill-being  are  often  insignificant  in 
comparison  with  the  gravity  of  the  disease.  Affections  of 
the  bowels  are  invariably  attended  by  mental  depression,  by 
melancholy  and  wretchedness  more  or  less  acute  and 
profound,  and  this  is  the  case  whether  or  no  the  patient 
recognizes  that  he  suffers  from  such  a  disorder.  In  affec- 
tions of  the  genito-urinary  apparatus,  in  addition  to  the 
feeling  of  illness  common  to  all  maladies,  there  is  an 
irritability  of  temper,  and  often  an  hypochondriacal 
attention  to  the  disease,  which  is  peculiar  to  disorders  of 
this  class. 

While,  however,  it  is  to  nerve  currents  internally  arising 
and  internally  distributed  that  Ave  are  indebted  for  those 
variations  of  nervous  discharge  in  the  central  masses  that 
have  all  these  varieties  of  pains  and  miseries  for  their  mental 
accompaniments,  it  is  to  currents  of  the  same  class  that  we 
owe  that  condition  of  nerve  pressure  which  has  for  its 
mental  side  the  feeling  of  well-being-  that  we  experience  in 


94  SANITY    AND    INSANITY. 

robust  health  and  vigour,  and  which  is  the  foundation,  if 
not  the  immediate  occasion,  of  all  our  feelings  of  happiness. 
All  conditions  of  pain  are  conditions  of  low  nerve  pressure, 
and  especially  in  those  massive  and  voluminous  and  un- 
localized  forms  of  pain  which  we  call  depression  and  misery 
and  unhappiness,  the  tension  in  the  nerve  centres  is  slack 
and  feeble.  When,  however,  all  the  organs  are  acting 
normally,  smoothly,  and  vigorously,  then  the  currents  they 
transmit  to  the  centre  are  full  and  powerful,  the  return 
currents  evoked  are  full  and  powerful,  the  reverberation  of 
these  powerful  discharges  spreads  through  the  whole  nervous 
system  and  evokes  a  heightened  tension,  and  this  tension  is 
sustained  and  increased  by  the  efficient  nutrition  provided 
to  the  whole  nerv^ous  system  by  a  body  of  viscera  working 
actively  and  harmoniously.  Our  general  disposition  of  mind 
to  happiness  or  the  reverse  depends,  then,  primarily  on  the 
molecular  tension  throughout  the  lesser  or  visceral  circulation 
of  nervous  energy  ;  overflow  of  spirits  and  sense  of  well- 
being  being  high  in  proportion  as  the  tension  is  great,  and 
vice  versa.  The  degree  of  tension  depends  primarily  on  the 
constitution  of  the  individual  nervous  system,  as  vigorous  or 
the  reverse  ;  secondarily,  on  the  smooth  and  healthy  action 
of  the  viscera,  determining  incoming  and  outgoing  dis- 
charges of  normal  vigour  ;  and  thirdly,  on  the  efficiency 
of  the  nutrition  of  the  nervous  system  as  effected  by 
these  viscera.  These  being  the  foundations  in  the  coenaes- 
thesis  of  a  sense  of  well-being,  it  only  remains  that  the  other 
portion  of  consciousness,  answering  to  our  commerce  with 
the  outside  world,  to  be  free  of  painful  elements,  for  us  to 
experience  a  general  feeling  of  contentment  and  satisfaction  ; 
and  should  there  be  in  this  other  moiety  of  consciousness 
elements  of  positive  pleasure,  our  mental  condition  will  rise 
from  mere  contentment  to  active  enjoyment  and  delight. 

That  our  pleasures  depend  in  some  degree  upon  the 
nature  of  our  commerce  with  the  world  outside  us,  as 
harmonious  and  successful  or  the  reverse,  needs  no  demon- 
stration ;  nor  does  the  dependence  of  our  happiness  on  the 


THE    MIND.  95 

healthy  state  of  our  viscera  and  organism  generally  need 
insistence.  As  to  the  dependence  of  our  sense  of  well-being 
upon  the  degree  of  tension  of  the  nervous  energy,  it  is 
evident  that  if  it  so  depends,  then  variations  in  the  tension 
will  be  accompanied  by  variations  in  the  feeling  of  well- 
being.  That  such  variations  do  occur,  and  occur  in 
correspondence,  needs  but  little  exposition.  Diurnal  tides  in 
the  nervous  energy  are  familiar  to  every  one  but  the  most 
vigorous  and  the  least  observant.  Daily  experience  shows 
us  that  on  first  \vaking  in  the  morning  we  are  lethargic,  that 
we  have  little  tendency  to  move,  and  less  to  rise,  and  that 
with  this  lethargic  condition,  indicative  of  low  nervour. 
tension,  there  is  a  certain  want  of  buoyancy  in  the  mind; 
small  difficulties  seem  great,  great  difficulties  insuperable. 
In  a  short  time  the  tide  of  energy  rises,  we  bounce  out  of 
bed,  dress,  and  get  to  work,  and  in  the  early  part  of  the 
forenoon  reach  at  once  our  condition  of  greatest  activity  of 
body,  and  our  condition  of  greatest  hopefulness,  confidence, 
and  cheerfulness  of  mind.  As  night  closes  in,  the  bodily 
energy  diminishes  ;  we  are  less  inclined  to  exertion,  and 
more  to  repose,  and  at  the  same  time  the  buoyant  confidence 
of  the  morning  diminishes,  and  we  become  more  cautious, 
less  adventurous.  As  the  hours  wear  on,  the  bodily  activity 
becomes  less  and  less  ;  with  fatigue  comes,  if  not  actual 
depression,  at  least  soberness  and  want  of  enterprise,  and 
when  the  small  hours  of  the  morning  are  reached  the  tide  of 
energy  is  at  its  lowest  ebb.  If  we  wake  between  three  and 
four  in  the  morning,  how  different  do  our  surroundings  and 
prospects  seem  to  what  they  were  at  noon  !  Difficulties 
that  then  were  trifling  now  appear  insuperable  ;  odd  sensa- 
tions that  in  the  turmoil  of  the  day  Avere  unperceived, 
unnoticed,  now  not  only  become  startlingly  prominent,  but 
appear  to  be  alarming  forebodings  of  serious,  nay,  fatal 
disease.  For  us  the  sun  has  indeed  gone  down,  and  the 
darkness  without  and  within  fills  us  with  "  baleful  visions 
of  eternal  woe,  and  desolation  dire."  Presently  we  fall 
asleep,  the  nervous  system  recuperates,  tension  is  restored, 


q6  sanity  Axn  insanity. 

the  tide  of  energy  rises,  and  when  we  rise  in  the  morning 
the  host  of  vampires  has  fled  with  the  night. 

^Vith  longer  periodicity  than  the  diurnal  tides,  recur  times 
of  days  or  weeks  duration  when  the  bodily  activity  is  great, 
when  strenuous  exertion  is  not  only  pleasurable  but  an 
imperious  necessity,  Avhen  pleasures  are  appreciated  with  a 
keener  zest,  when  difficulties  are  met  with  determined 
obstinacy,  and  reverses  fail  to  produce  depression  ;  and 
alternating  with  these  periods  are  times  of  lethargy  and 
weariness — times  when  strenuous  exertion  is  a  laborious 
effort,  when  obstacles  dismay  and  failures  dishearten.  In 
each  case  the  general  mental  state  of  happiness  or  depression 
corresponds  with  the  bodily  capability  of  exertion,  and  with 
the  general  indications  of  high  or  low  nervous  tension. 
Lastly,  the  difference  between  the  restless,  boisterous  activity 
of  youth,  with  its  insensibility  to  fatigue  and  its  rapid 
recuperation  after  exhaustion,  and  the  phlegmatic  repose  of 
age,  so  readily  fatigued  and  so  long  in  recovering,  corresponds 
with  the  difference  between  the  proverbial  hopefulness  of  the 
one,  which  looks  forwards  on  a  roseate  world,  and  the  equally 
proverbial  placidity  of  the  other,  Avhich  looks  backwards  on 
a  world  dyed  with  the  grey  tint  of  experience  ;  and  each 
owes  its  respective  qualities,  both  bodily  and  mental,  to 
the  condition  of  the  nervous  tension,  high  >in  the  one  and 
low  in  the  other. 


CHAPTER  III. 


WHAT    INSANITY   IS. 


The  difficulty  of  precisely  defining  the  nature  of  insanity, 
or  of  saying  precisely  what  insanity  is,  has  been  recognized, 
not  only  by  every  writer  on  the  subject,  but  by  all  those 
who  have  had  to  deal  practically  with  the  insane,  whether 
medical  men,  judges,  or  legislators.  A  very  high  legal 
authority — Lord  Justice  Blackburn — giving  evidence  before 
a  select  committee  of  the  House  of  Commons,  said — "  I 
have  read  every  definition  which  I  could  meet  with,  and 
never  was  satisfied  with  one  of  them,  and  have  en- 
deavoured in  vain  to  make  one  satisfactory  to  myself. 
I  verily  believe  that  it  is  not  in  human  power  to  do  it." 
Very  high  medical  authorities — Dr.  Bucknill  and  Dr.  Hack 
Tuke — in  their  great  work  on  psychological  medicine,  say — 
"  We  believe  it  to  be  impracticable  to  propose  any  definition 
entirely  free  from  objection,  which  shall  comprise  every 
form  of  mental  disorder.  Every  definition  hitherto  pro- 
posed has  failed  either  to  include  all  the  conditions  under 
which  insanity  exists  or  to  exclude  all  in  which  it  does  not, 
and  the  more  laboriously  the  definition  is  constructed  the 
more  decided  is  usually  the  failure."  ^ 

^  As  a  sample  of  the  proposals  that  have  been  made  to  define  insanity, 
tlie  following,  Ijy  an  American  writer,  may  be  instanced;  "Insanity  is 
either  the  inability  of  the  individual  to  correctly  register  and  reproduce 
impressions  (and  conceptions  based  on  these)  in  sufficient  number  and 
intensity  to  serve  as  guides  to  actions  in  harmony  with  the  individual's  age, 
circumstances,  and  surroundings,  and  to  limit  himself  to  the  registiation  as 
sul)jective  realities  of  impressions  transmitted  by  the  peripheral  organs  of 


98  SANITY    AND    INSANITY. 

The  most  authoritative  definitions  are  of  course  those 
which  are  propounded  by  the  law  ;  and  it  is,  for  scientific 
purposes,  unfortunate  that  the  law  lays  down  three  widely- 
different  definitions  of  what  it  recognizes  as  insanity.  In 
criminal  cases  the  legal  test  of  insanity  is  the  knowledge  of 
right  and  wrong  ;  that  is  to  say,  a  criminal  is  considered  to 
have  been  sane  when  he  committed  his  crime  if  "he  then 
knew  the  nature  and  quality  of  the  act,  and  that  it  was 
wrong."  So  that  conversely  a  person  is  insane  if  he  does 
an  act  Avhose  nature  and  quality  (whatever  that  may  mean) 
he  does  not  know,  or  if,  knowing  the  nature  and  quality  of 
his  act,  he  does  not  know  whether  it  is  right  or  wrong. 

In  testamentary  cases  the  requirement  of  the  law  is 
different.  Here  the  nature  and  quality,  the  rightness  or 
wrongness  of  the  act,  are  not  considered.  A  testator  is  con- 
sidered to  be  sane  if  he  is  "  of  sound  mind,  memory,  and 
understanding  ; "  and  conversely  he  is  insane  if  his  mind, 
his  memory,  or  his  understanding  is  unsound.  In  this  case 
the  question  of  the  knowledge  of  the  nature  and  quality,  or 
of  the  rightness  or  wrongness  of  the  act,  does  not  arise. 

In  a  third  class  of  cases  a  third  test,  different  from  both  of 
the  preceding,  is  required  by  the  law,  and  this  class  is  the 
more  important  because  in  it  alone  is  the  question  of  the 
sanity  or  insanity  of  a  person  directly  raised.  In  criminal 
cases  the  issue  is  raised  quasi-incidentally,  and  much  evi- 
dence bearing  on  the  question  is  often  excluded  by  the  forms 
of  legal  procedure.  In  testamentary  cases  the  issue  is  the 
validity  of  an  instrument  executed  by  the  person,  and  the 
question  of  his  sanity  arises  again  quasi-incidentally.  But 
in  an  inquisition  in  lunacy  the  actual  issue  placed  before  the 
jury  is — Is  the  subject  of  this  inquisition  sane  or  insane  ?  And 

sen.salion  ;  or  the  failure  to  properly  co-ordinate  such  impressions  and  to 
thereon  frame  logical  conclusions  and  actions  :  these  inabilities  and  failures 
being  in  every  instance  considered  as  excluding  the  ordinary  influence 
of  sleep,  trance,  somnambulism,  the  common  manifestations  of  general 
neuroses,  such  as  epilepsy,  hysteria,  and  chorea,  of  febrile  delirium,  coma, 
acute  intoxications,  intense  mental  preoccupation,  and  the  ordinary  effects 
of  nervous  shock  and  injury." 


WHAT    INSANITY   IS.  99 

to  the  test  applied  by  an  inquisition  more  importance  there- 
fore attaches.  This  test  is  as  follows:  Is  the  patient  in- 
capable of  managing  himself  and  his  af^airs  f  It  will  be 
seen  that  this  test  is  very  widely  different  and  of  very  far 
more  comprehensive  scope  than  either  of  the  others.  In 
both  the  previous  cases  the  jury  have  to  get,  as  it  were, 
inside  the  man's  mind,  and  to  guess  as  best  they  may  at  what 
was  the  condition  of  his  consciousness  on  a  certain  date. 
They  have  to  determine  what  he  then  knew,  what  he 
thought,  what  was  the  state,  and  what  the  validity,  of  his 
memory  and  his  judgment.  Now  it  is  obvious  that  there  is 
only  one  person  who  can  possibly  know  the  state  of  a  man's 
memory,  of  his  knowledge,  and  of  his  judgments — and  that 
person  is  the  man  himself.  Whatever  we  know  about  the 
interior  of  other  people's  consciousness,  we  know  only  by 
inference — by  judging  from  their  actions  what  the  condition 
of  their  consciousness  is  likely  to  be  ;  supposing  that  actions 
are  in  them  accompanied  by  states  of  consciousness  similar 
to  those  which  in  us  accompany  like  actions  of  our  own. 
As  a  matter  of  fact,  we  know  by  daily  experience  that  like 
actions  may  be  preceded  and  accompanied  by  very  different 
states  of  consciousness  ;  or,  as  we  say,  that  similar  conduct 
may  be  prompted  by  very  different  motives  ;  so  that  our 
knowledge  of  the  state  of  other  people's  consciousness  is  not 
only  inferential,  but  uncertain.  In  the  third  class  of  cases, 
however,  the  subject-matter  of  the  investigation  is  very 
different.  In  an  inquisition  in  lunacy  the  jury  have  to 
determine  whether  the  person  is  capable  of  managing  him- 
self and  his  affairs  ;  and  this  they  can  do  by  immediate 
inference  from  observation  of  whether  he  docs  manage  him- 
self and  his  affairs  capably.  In  this  case  there  is  no  question 
of  getting  into  a  man's  mind,  and  observing  the  feelings  and 
thoughts  that  are  passing  therein.  Here  we  have  only  to 
look  to  his  conduct^  which  is  open  to  our  direct  observation. 
In  propounding  this  test  the  law  has  recognized  and  sup- 
plied an  omission  which  has  vitiated  and  spoilt  every 
medical   definition  of  insanity  that  has  ever  been  proposed. 


lOO  SANITY    AND    INSANITY. 

Not  only  do  the  laity  regard  insanity  as  a  disorder  of  the 
mind,  but  all  the  numerous  medical  definitions  of  insanity — 
and  every  writer  on  the  subject  has  proposed  at  least  one — 
however  much  they  may  differ  in  other  respects,  agree  in 
this — that  they  regard  insanity  solely  as  a  mental  disorder. 
This  is  the  first  misconception  of  which  the  student  of  in- 
sanity has  to  rid  himself.  Insanity  is  always  regarded  as  a 
disorder  of  the  mind.     It  is  not  so. 

Of  course,  disorder  of  mind  is  always  present  in  insanity, 
and  salt  is  always  present  in  sea-water  ;  but  sea-water  is  a 
different  thing  from  table-salt,  and  insanity  is  a  different 
thing  from  mental  disorder.  There  are  many  disorders  of 
the  mind  which  are  not  insane.  Here  is  a  person  who, 
when  you  show  him  a  red  light,  has  a  feeling  not  of  red, 
but  of  grey.  The  agent  which  should  arouse  one  feeling 
arouses  another.  His  feelings  are  disordered.  But  we  do 
not  call  him  insane,  we  say  he  is  colour-blind.  Here  is 
another  person  who,  on  the  approach  of  a  migraine,  sees  in 
front  of  him  a  little  ring  of  colour  revolving.  Wherever 
he  turns  he  sees  between  him  and  the  nearest  object  this 
little  moving  coloured  ring.  He  has  a  feeling  of  colour 
which  has  no  external  origin;  he  perceives  an  object  where 
no  object  exists;  he  has  a  disorder  of  feeling  and  a  disorder 
oT  perception  ;  his  mind  is  disordered,  but  he  is  not  insane. 
A  man  calls  on  me  with  a  little  bill.  I  look  at  it,  and  see 
that  the  amount  is  13s.  6d.  I  count  out  the  money  and  give 
it  to  him,  when  he  surprises  me  by  stating  that  the  amount 
should  be  15s.  6d.  I  look  at  the  bill,  and  there,  sure  enough, 
the  figure  which  I  took  to  be  a  3  is  plainly  a  5.  There 
can  be  no  doubt  about  it,  I  have  made  a  mistake.  The 
figures  are  plainly  written,  the  light  is  good,  my  eyesight  is 
unimpaired.  I  can  only  apologize,  and  in  doing  so  say, 
"  I  certainly  thought  the  amount  was  13s.  6d."  Here,  then, 
was  an  erroneous  perception.  The  process  of  perception, 
which  is  of  course  a  mental  process,  was  disordered.  There 
was  disorder  of  mind;  but  there  was  no  insanity.  The 
foregoing    instances    are    very    simple  ;     but    feeling    and 


WHAT    INSAXITY    IS.  lOI 

thought,   when    they    reach    much    higher    levels,    are    still 
susceptible  of  disorder,  without  such  disorder  being  neces- 
sarily insane.     A  man  comes  home   from  business  after  a 
worrying  and   anxious  day,  and  on    sitting  down  to  dinner 
finds  the  soup  smoked,  the  fish  stale,  and  the  joint  tough. 
After  dinner  he  discovers  that  a  paper  which  he  left  on  his 
table  in  the  morning  has  been  mislaid,  and  this  occurrence 
evokes  an  outbreak  of  temper  altogether  out  of  proportion 
to  the  event.     He  becomes  extremely  angry,  and  this  intense 
feeling  of  anger  is  quite  out   of   proportion   to  the   trivial 
circumstance  which  aroused  it.     In  other  words,  the  process 
of  feeling  is  disordered,  so  that  feelings  are  no  longer  in  pro- 
portion to  circumstances  ;    and  this   disorder  of  feehng  is 
a  disorder   of  mind,  but  it  is  not  insanity.     That  the  out- 
break of  anger  is  a  disorder  of  mind,  and  is  an  approach  to 
insanity,  is  seen  by  the  old  saying,  Ira  furor  hrcvis  est;  that 
it  is  not    actual  insanity,  is  of  course.     A  farmer  travelling 
in  a  new  district  sees  a  crop  which  is  new  to  him  flourishing 
luxuriantly,   and  finds    that    it    is  easy   of    cultivation    and 
extremely  profitable.     He  goes  home  and  introduces  it  upon 
his  own  land,  with  the  hope  of  realizing  handsome  profits, 
but  the  result  is  failure  and  loss.     He  has  neglected  to  take 
into  consideration  the  difference  between  the  two  localities 
in  soil,  climate,  and  position,  and   this  neglect   to  consider 
important  factors  in  the  problem  before  him  was  a  defect  in 
his    process    of    reasoning.      The    reasoning,  by  which   he 
arrived  at  the  conclusion  that  the  crop  would   be  profitable 
to  him,  was  defective  ;  the  mental  process  was  disordered. 
But  this  defect  or  disorder  of  mind  was  not  insanity.   Clearly, 
then,  disorder  of  mind,  including  disorder  both  of  thought 
and  of  feeling,  both  in  their  lower  and  higher  manifestations, 
may  exist  without  insanity. 

Not  only  may  disorder  of  mind  exist  without  insanity, 
but  in  insanity  there  is  much  besides  disorder  of  mind. 
Suppose  that  you  see  a  man  reading,  or  walking,  or  eating 
his  dinner,  or  doing  any  act  you  please,  and  doing  it 
normally  and  in  the  customary  manner;   that  man  may  be 


102  SANITY   AND   INSANITY. 

deeply  and  hopelessly  insane,  but  you,  seeing  him  act 
normally,  do  not  suspect  his  insanity  for  a  moment.  If  he 
reads  aloud,  and  reads  the  same  sentence  over  and  over 
again  in  a  loud,  aggressive  tone  of  voice ;  or  if  he  skips  and 
dances  along  the  road  with  his  boots  off  and  his  coat  turned 
inside  out ;  or  if  he  tries  to  feed  himself  through  his  ears 
instead  of  his  mouth  ;  you  recognize  at  once  that  he  is  insane ; 
but  you  do  not  form  your  judgment  on  the  ground  of  what 
is  passing  in  his  mind — of  anything  that  he  thinks  or  feels. 
It  does  not  occur  to  you  to  suspend  your  judgment  until 
you  have  investigated  the  motives  which  induce  him  to  act 
in  this  manner.  The  fact  that  he  does  so  is  evidence  enough. 
That  is  to  say,  you  ground  your  judgment  of  his  insanity 
not  on  what  he  thinks  or  feels  but  on  what  he  does;  not 
upon  inferred  disorder  of  mind,  but  on  perceived  disorder  of 
conduct.      It  has   happened    that  many  people   have  been 

troubled   by  hallucinations.     Mrs.   A ,   the   lady  whose 

case  has  become  celebrated  by  the  report  of  Sir  David 
Brewster,  frequently  saw  a  spectral  cat,  and  heard  unspoken 
voices,  her  mind  being  therefore  distinctly  disordered  ;  but 
since  her  conduct  was  in  every  respect  normal,  the  question 
of  insanity  did  not  arise.  It  has  happened  in  attacks  of  petit 
mal^  that  a  man  suddenly  becomes  entirely  unconscious  ; 
and  while  in  this  unconscious  condition  Avill  walk  for  a  con- 
siderable distance,  will  climb  over  stiles,  get  through  gates, 
avoid  passing  carts,  and  even  answer  when  spoken  to;  and  so 
long  as  he  conducts  himself  normally,  no  question  of  insanity 
arises  in  the  minds  of  the  bystanders,  although  his  mind  is 
for  the  time  being  absolutely  annulled.  If,  however,  his 
conduct  should,  during  this  period  of  unconsciousness, 
become  abnormal — if,  for  instance,  he  should,  as  such 
patients  often  do,  begin  to  undress  himself  in  the  middle  of 
the  road  in  broad  daylight,  and  on  being  remonstrated  with 
break  out  into  extreme  violence,  he  would  at  once  be  con- 
sidered insane  ;  and  he  would  be  so  considered  although  his 
mind  were  altogether  absent,  and  could  scarcely  therefore  be 
called  disordered. 


WHAT    INSANITY   IS.  IO3 

Even  when  we  avowedly  ground  our  judgment  of  insanity 
upon  mental  disorder — upon,  for  instance,  the  existence  of 
a  delusion — we  really  and  indeed  actually  ground  it  upon 
conduct  ;  for  only  by  conduct  can  mind  be  known.  Suppose 
the  delusion  is  known  to  us  by  the  patient's  description,  and 
that  we  learn  it  by  conversation  with  him,  still  conversation 
is  but  oral  conduct.  Putting  this  view  aside,  however,  it  is 
not  from  mere  oral  description  that  we  should  conclude  that 
a  person  suffered  from  an  insane  delusion.  We  should  not 
regard  its  existence  as  proved  until  we  had  the  evidence  of 
overt  acts.  A  man  might  assure  us  repeatedly  and  day 
after  day  that  he  was  Emperor  of  China,  but  if  he  con- 
ducted his  business  successfully,  and  if  his  conduct  towards 
his  servants,  his  family,  his  friends,  and  all  his  surroundings, 
was  normal  and  proper,  we  should  never  consider  him  insane. 
But  if  he  were  to  go  to  town  with  a  yellow  silk  umbrella,  we 
should  begin  to  look  on  him  with  suspicion  ;  and  if  he  were 
to  send  yellow  buttons  to  distinguished  strangers  as  a  mark 
of  distinction  and  favour,  we  should  no  longer  doubt  that  he 
suffered  from  insane  delusion.  Here,  again,  the  test  of 
insanity  is  not  mental  condition,  but  conduct. 

If  we  consider  the  matter  in  the  light  of  what  has  been 
said  in  the  previous  chapters,  we  shall  see  that  it  is  in  fact 
impossible  for  mind  alone  to  be  disordered.  For  feelings  and 
thoughts,  mental  states  and  mental  processes,  are  but  the 
shadows  or  accompaniments  of  nervous  states  and  nervous 
procesess  ;  and  since  no  mental  change  can  occur  save  as  the 
shadow  or  accompaniment  of  a  nervous  change,  so  a  fortiori 
no  mental  disorder  can  occur  except  as  the  shadow  or 
accompaniment  of  a  nervous  disorder.  Whenever,  therefore, 
there  is  disorder  of  mind,  there  must  be  disorder  of  nervous 
processes — of  those  processes  which  have  a  mental  accompani- 
ment— that  is  to  say,  of  those  which  are  highest.  But  the 
highest  nervous  processses  are  those  which  regulate  the 
movements  of  the  body  with  respect  to  the  circumstances  in 
the  outside  world — are,  in  fact,  those  which  actuate  conduct. 
Hence,  when  these  highest  nervous  processes  are  disordered, 


104  SANITY   AND    INSANITY. 

not  only  must  mind  be  disordered,  but  conduct  must  be  dis- 
ordered also.  While,  therefore,  we  find  from  observation, 
that  as  a  matter  of  fact  disorder  of  mind  is  not  the  only 
deviation  from  the  normal  in  insanity,  on  the  other  hand 
we  find  from  the  principles  already  laid  down,  that  mental 
disorder  cannot  exist  alone,  but  must  always  be  accompanied 
by  disorder  of  nervous  processes,  and  disorder  of  conduct.  We 
have  already  seen  that  the  essential  and  necessary  factor  in 
insanity  is  disorder  of  conduct,  and  we  have  seen,  too,  that 
in  insanity  disorder  of  mind  is  always  present  ;  and  the 
co-existence  of  these  two  disorders  implies  and  necessitates 
disorder  of  those  highest  nervous  processes  which  actuate  the 
one  and  accompany  the  other  ;  so  that  any  expression  which 
indicates  the  true  and  full  nature  of  insanity,  must  be  one 
which  will  include  and  sum  up  these  three  disorders,  and 
express  them  in  a  single  proposition. 

Movements  of  the  body  as  a  whole  have  been  spoken  of  as 
equivalent  to  conduct,  but  this  equation  of  terms  is  only 
provisional  and  approximate.  A  more  accurate  expression 
must  now  be  submitted.  Conduct  may  mean — ?>.,  our 
affairs  may  be  conducted  by — movements  very  much  less 
than  those  of  the  whole  body — by  a  shrug,  a  smile,  a  wink  ; 
nay,  by  the  very  absence  and  suppression  of  movement  ; 
and  there  are  movements  of  the  whole  body — such,  for 
instance,  as  yawns  and  convulsions — which  cannot  be  con- 
sidered conduct.  We  may,  indeed,  substitute  for  conduct,  as 
has  been  done  in  the  earlier  part  of  the  book,  the  phrase 
''  purposive  movement,"  and  so  far  be  accurate  ;  but  then 
will  at  once  arise  the  question,  How  purposive  ?  What  is 
meant  by  a  purposive  action  and  a  purpose  ? 

The  answer  is  this  :  those  actions  are  considered  to  be 
purposive,  those  movements  are  considered  to  belong  to 
conduct,  by  which  the  individual  adapts  himself  to  the  cir- 
cumstances which  surround  him.  Such  movements  must 
always  concern,  if  they  do  not  always  involve,  the  entire 
organism  ;  and  thus  differ  from  movements  of  parts  of  the 
body  with  reference  to  one  another,  and  without  reference 


WHAT   INSANITY    IS.  IO5 

to  surrounding  circumstances,  which  belong  to  the  domain 
of  physiology,  and  do  not  concern  the  psychologist.    The  same 
movement    may,  under  different  circumstances,    belong    to 
the  one  or  to  the  other  category.     For  instance,  the  closing 
of  the  eyelids,  which  serves   to  keep  the  surface  of  the  eye 
lubricated  and  clean,  is  as  purely  physiological  a  movement 
as  that  of  the  jaws  in  mastication,  of  the  gullet  in  swallowing, 
or  of  the   stomach  in  digestion.     All  these  movements  are, 
in  a  sense,  purposive,  since  each  subserves  an  end,  but  none 
are    intelligent,   and    none  belong  to  conduct  ;  the    reason 
being  that  each  has  direct  reference  to  such  conditions  only 
as  are  included  entirely  within  the  precincts  of  the  organism 
itself.     None  of  them  is  a  direct  adaptation  to  surrounding 
circumstances.     But  when  the  eyelids  close  in  answer  to  the 
stimulus  of  a  too  brilliant  light,  the  affair  is  a  very  different 
one.     The  movement  is  now  an  adaptation  to  conditions — 
the    existence    of  a    bright    light  —  altogether    outside    the 
organism  itself ;  and  now,  instead  of  being  a  mere  vegetative 
movement,  it  is  an  intelligent  movement  ;  instead  of  being 
a  purely  physiological  affair,  it   has  come  into  the  region  of 
conduct  ;  and  its  consideration  belongs  to  the  psychologist. 
When  the  lids  are  lowered  to  avoid  a  searching  gaze,  the 
case  is  again  a  movement  in   adaptation  to  circumstances. 
The  circumstances  to  which  the  movement   is  adapted   are 
now  of  a  far  more  complex  character  ;  instead  of  merely  the 
existence  of  a  simple  luminous  body,  there  is  the  existence  of 
a  being  like  ourselves,  whom  we  credit  with  certain  know- 
ledge, certain  motives,  certain  abilities  to  discern  our  feel- 
ings and  the  state  of  our  mind  from  our  looks,  and  so  forth, 
and  in  answer  in  adaptation  to  this  complex  of  attributes  in 
the  object  outside  of  us,  the  movement  is  made.     The  move- 
ment is  a  direct  adaptation  to  circumstances  outside  of  us,  and 
is  therefore  an  intelligent  movement,  and  a  part  of  conduct. 
In   the  foregoing  cases  the  immediate  adjustment  of  the 
individual  to  surroundings  of  different  degrees  of  complexity 
has    been    effected   by    similar   simple    movements.      It    is 
evident  that  there  are  all  degrees  of  complexity  in  the  cir- 


I06  SANITY    AND    INSANITY. 

cumstances  outside  of  us  that  have  to  be  met  and  dealt 
with,  and  similarly  there  are  all  degrees  of  elaborateness  in 
the  acts  by  which  we  meet  and  deal  with  circumstances  ;  and 
the  rule  is  that  the  complexity  of  the  circumstances  dealt 
with  is  reflected  in  the  elaborateness  of  the  conduct  by 
which  the  individual  adjusts  himself  to  them.  Thus,  to  step 
over  a  fallen  trunk  that  lies  across  our  path  is  a  very  simple 
act,  by  which  we  adapt  ourselves  to  a  very  simple  circum- 
stance. To  nurse  a  parliamentary  constituency  by  buying 
lands  and  houses,  subscribing  to  local  'societies,  clubs  and 
charities,  promoting  local  undertakings,  speaking  at  local 
meetings,  and  ingratiating  oneself  with  the  local  population, 
is  an  immensely  elaborate  series  of  acts  adapted  to  an 
immensely  complex  combination  of  circumstances.  However 
simple  or  complicated  the  circumstances,  and  however  simple 
or  elaborate  the  acts  by  which  theyare  dealt  with,  the  same  law 
obtains  throughout,  viz.,  every  movement  that  forms  a  part 
of  conduct,  every  act  that  can  be  considered  intelligent,  is  an 
adaptation  of  the  organism  to  surrounding  circumstances,  or, 
briefly  put,  conduct  is  the  adjustment  of  the  organism  to  its 
environment.  Consequently,  erroneous  conduct  is  an  error 
in  the  adjustment  of  the  organism  to  its  environment,  and 
disordered  conduct  is  disorder  of  this  adjustment.  If,  in 
stepping  over  the  fallen  trunk,  I  do  not  lift  the  foot  high 
enough,  but  trip  and  fall,  the  act  is  not  accurately  adjusted 
to  the  circumstances.  There  is  failure  of  the  adjustment. 
And  if  the  candidate  for  parliament  takes  a  course  on  some 
burning  question  which  alienates  the  suff'rages  of  a  large 
party  in  the  constituency,  and  thus  loses  him  the  election, 
there  is  similarly  a  failure  in  the  accuracy  of  the  adjustment 
of  his  acts  to  his  circumstances. 

If  this  be  the  nature  of  conduct,  then  it  follows  that  feel- 
ing, which  is  the  motive  of  conduct,  and  thought  or  intelli- 
gence, of  which  conduct  is  the  external  expression,  must  also 
bear  some  definite  relation  to  the  circumstances  in  which  the 
organism  exists  and  acts,  or,  as  we  say,  to  its  environment. 
Let  us  see  what  these  relations  are. 


WHAT   INSANITY    IS.  IO7 

When  I  have  a  feeling  of  warmth,  I  have  a  certain  state  of 
consciousness,  or,  more  accurately,  my  consciousness  includes 
a  certain  state.  Now  this  mental  state  is  simultaneous  with 
the  action  upon  me  of  ethereal  waves  permeating  my 
environment  and  beating  on  my  body.  As  long  as  the 
action  of  the  waves  on  me  lasts,  the  feeling  lasts.  The  feel- 
ing corresponds  with  the  action  in  duration.  The  greater 
the  amplitude  of  the  waves,  and  the  more  intense  their 
action  on  me,  the  warmer  1  feel,  the  more  intense  is  the  feel- 
ing. The  state  of  consciousness  corresponds  with  the  action 
in  intensity.  If  the  feeling  arises  from  getting  into  a  warm 
bath,  it  is  of  greater  volume  than  if  it  arises  from  putting 
merely  a  hand  or  a  limb  in  the  water  ;  and  the  larger  the 
surface  acted  on,  the  greater  the  mass  of  the  feeling.  The 
state  of  consciousness  corresponds  with  the  action  in  volume. 
In  duration,  in  intensity  and  in  volume,  in  every  respect, 
that  is  to  say,  in  which  they  are  comparable,  the  state  in  the 
organism  corresponds  with  the  action  upon  it  of  the  agent  in 
the  environment.  When  I  have  a  feeling"  of  anger,  this  feel- 
ing is  a  state  in  me  which  is  aroused  by  the  action,  actual  or 
incipient,  of  some  external  antagonistic  agent  upon  me. 
Whereas  the  feeling  of  warmth  corresponded  directly  with 
the  action  of  the  ethereal  waves,  being  simultaneous  with 
the  duration  of  their  action,  and  varying  directly  Avith  their 
intensity  and  volume  ;  the  feeling  of  anger  corresponds 
only  indirectly  with  the  action  of  the  antagonistic  agent,  for 
it  may  arise  while  that  action  is  impending,  before  it  has 
become  actual,  or  while  it  is  going  on,  or  after  it  has  ceased. 
It  may  arise  in  correspondence  with  an  action  which  never 
actually  takes  place,  but  is  threatened  only.  This  indirectness 
of  the  correspondence  of  the  state  in  the  organism  with  the 
action  upon  it,  involves  a  difference  in  the  rank  of  the  feeling, 
which  is  not,  as  in  the  previous  case,  a  simple  sensation,  but 
an  emotion.  Although,  however,  the  correspondence  is 
indirect,  it  is  maintained.  So  long  as  the  action  of  the  agent 
on  me  is  antagonistic,  so  long  the  feeling  is  one  of  anger  ; 
but  if  the  action  alters  and  becomes  beneficent,  the  feeling 


I08  SAXITY    AND    INSANITY. 

alters  and  becomes  kindly.  That  is  to  say,  the  quality  of 
the  feeling  corresponds  with  the  quality  of  the  action. 
Again,  if  the  antagonism  is  but  slight,  the  feeling  is  slight  ; 
if  the  one  is  intense,  the  other  also  is  intense.  The  feeling 
corresponds  with  the  action  in  intensity.  In  quality  and 
in  amount  the  state  in  the  organism  corresponds  with  the 
action  upon  it  of  an  agent  in  the  environment.  When  I 
have  a  feeling  of  freedom,  this  feeling  is  a  state  in  me  which 
is  aroused  by  the  experience  of  lack  of  restraint  to  my  own 
actions.  The  quality  of  the  feeling  (freedom)  depends  on 
the  quality  (unrestrainedness)  of  my  actions.  The  amount 
of  the  feeling  depends  on  the  degree  to  which  restraint 
is  lacking.  Both  in  quality  and  in  amount,  the  feeling 
corresponds  with  the  action  of  the  organism  on  the  en- 
vironment. Similarly,  every  case  of  feeling  is  the  occur- 
rence of  a  state  in  the  organism  in  correspondence  with 
an  interaction  between  the  organism  and  its  environ- 
ment. 

Although,  however,  feeling  always  corresponds  with  an 
interaction,  yet  it  is  not  always  adjusted  to  the  interaction 
with  which  it  corresponds.  The  feeling  of  cold,  which  I  now 
experience,  corresponds  with  a  diminution  of  amplitude  of 
the  ethereal  waves  that  are  breaking  on  the  surface  of  my 
body,  and  is  intense  in  proportion  to  the  diminution  of 
amplitude.  The  feeling  is  adjusted  to  the  action  with  which 
it  corresponds.  But  suppose  that  the  feeling  of  cold  attends 
the  shivering  fit  which  marks  the  invasion  of  blood-poison- 
ing. So  far  from  the  amplitude  of  the  heat-waves  that 
break  upon  me  being  diminished,  it  remains  the  same,  or 
may[actually  be  increasing.  Here,  then,  an  alteration  of  feel- 
ing corresponds  with  an  unaltered  action.  The  feeling  is 
unadjusted  to  the  action  with  which  it  corresponds.  Again, 
so  long  as  my  feeling  of  anger  corresponds  with  the  relation 
of  antagonism  to  me  on  the  part  of  some  agent  in  the  world 
outside,  so  long  it  both  corresponds  and  is  adjusted. 
But  if  the  agent  which  I  take  to  be  antagonistic  is  not 
antagonistic  at  all  ;  if  I  have  been  misled   by  appearances 


WHAT   INSANITY   IS.  IO9 

and  by  false  reports,  to  believe  in  an  antagonism  which  does 
not  exist ;  then  the  feeling  of  anger  is  no  longer  adjusted  to 
the  action  with  which  it  corresponds.  Again,  my  feeling 
of  freedom  corresponds  with  the  unrestrainedness  of  my 
actions.  But  suppose  that  while  I  have  been  writing,  some 
lover  of  mischief  has  quietly  locked  the  door  upon  me.  The 
feeling  of  freedom  corresponds  with  a  relation  that  no  longer 
exists.  It  corresponds,  but  is  unadjusted.  When  feeling  is 
erroneous,  therefore,  there  is  a  lack  or  a  failure  of  adjustment 
of  states  in  the  organism  to  the  circumstances  with  which . 
they  correspond  ;  and  when  feeling  is  disordered  there  is 
disorder  of  the  adjustment  of  the  organism  to  its  environ- 
ment. 

The  correspondence  of  thoughts  with  things  is  a  little 
more  complicated  than  that  of  feelings  with  actions. 
Thought,  Ave  already  know,  is  a  relation  between  feelings, 
and  hence,  as  each  feeling  has  its  corresponding  circumstance 
in  the  environment,  we  may  expect  to  find  that  thought 
corresponds  with  a  relation  betAveen  circumstances. 

When  I  perceive  that  this  object  before  me  is  a  horse, 
there  recurs  in  consciousness,  as  has  already  been  fully 
explained,  the  relation,  previously  established,  between  (this 
group  of  presented  mental  states,  of  colour,  shape,  size, 
movement,  &c.),  and  (this  other  group  of  remembered  states 
— the  sound  "horse"  and  the  remembrance  of  the  many 
qualities  that  I  have  found  in  experience  that  horses  possess). 
This  relation  of  proximity  or  cohesion  between  the  two 
groups  of  mental  states,  is  the  thought,  the  internal  process, 
the  mental  relation.  Now  Avhat  has  to  be  observed  is  that 
this  internal  relation  corresponds  with  an  external  relation, 
with  a  relation  of  co-existence  between  the  qualities  corre- 
sponding with  these  mental  states.  While  the  internal 
relation  is  (this  group  of  presented  states)  coheres  with  (that 
group  of  memories),  the  relation  in  the  environment  is  (this 
group  of  qualities — solidity,  colour,  shape,  size,  movement, 
&c.)  co-exists  Avith  (that  group  of  qualities — the  ability  to 
wear  harness,  draAV  carriages,  eat  corn,  &c.,  and  the  attach- 


no  SANITY    AXD    INSANITY. 

ment  of  the  name  horse).  To  put  the  matter  in  a  clearer 
form,  the  mental  relation,  the  thought  alone,  is — 

Mental  state.  Relation.  Mental  state. 

(This  group  of  presented  states)  coheres  with  (That  group  of  memories). 

while  the  state  of  things  that  we  now  have  to  consider,  when 
we  are  dealing  with  mental  processes,  no  longer  in  their 
simplicity,  but  in  correspondence  with  circumstances,  is — 

Internal  relation.  External  relation. 

These  mental  states  \  (  This  group  of  qualities 

cohere  with  r  corresponds  with    -'|            co-exists  with 

Those  mental  states.  J  I  That  group  of  qualities. 

What  is  true  of  percepts  is  evidently  true  of  memories  in 
general,  of  which  percepts  are  but  a  variety  ;  the  difference 
being  that  in  memories  proper  both  the  mental  terms  are 
purely  represented  or  revived  in  thought,  while  in  percepts 
one  term  contains  presented  feelings  or  sensations.  The 
general  formula  for  all  percepts  and  memories  will  be — 

Alental  relation.  Environmental  relation. 

1  .        f         .  .^  . 

coheres  with  :    corresponds  with    i  is  associated  with 

*  )  I  B 

In  other  words  :  when  one  group  of  mental  states  coheres 
with  another,  so  that  the  occurrence  of  the  one  drags  the 
other  after  it  into  consciousness,  it  is  because  the  qualities  of 
something  in  the  outside  world  which  acted  on  us  and 
aroused  the  first  state,  were  associated  with  other  qualities, 
which  immediately  afterwards  acted  on  us  and  aroused  the 
second  state.  The  first  state  of  mind  corresponded  with  the 
first  set  of  qualities,  the  second  state  with  the  second  set  ; 
and  the  relation  of  contiguity  or  cohesion  between  the  two 
states  of  mind  corresponded  with  the  relation  of  association, 
of  co-existence,  or  sequence,  between  the  two  sets  of  qualities. 


WHAT   INSANITY   IS.  Ill 

We  have  already  seen  how  two  nervous  processes  that  have 
followed  one  another  before,  tend  to  follow  one  another 
again  ;  and  how  two  states  of  mind  that  have  before  followed 
one  another  tend  to  follow  one  another  again  ;  and  we  now 
see  that  this  tendency  to  follow  one  another — this  cohesion — 
between  the  states  of  mind,  corresponds  with  an  association 
of  the  qualities  of  some  object  which  the  states  of  mind 
reflect. 

The  case  of  reasoning  is  a  little  different  from  that  of 
memory.  Reasoning,  we  have  seen,  consists  in  observing 
Hkenesses  and  differences.  That  is  the  internal  process. 
From  the  present  point  of  view,  reasoning  is  the  establish- 
ment of  likenesses  and  differences  among  mental  states,  in 
correspondence  with  likenesses  and  differences  between  the 
things  that  these  mental  states  represent.  For  instance,  if  I 
reason  that  the  strike  of  miners  is  likely  to  raise  the  price  of 
coal,  the  mental  process  is  (those  memories  of  sequences — of 
former  strikes  being  followed  by  raised  prices)  is  like  (this 
concept  of  a  sequence — this  strike  being  followed  by  raised 
prices).  Expanded  into  terms  of  correspondence  with  cir- 
cumstances, the  judgment  becomes — 

Mental  relation.  Environmental  relation. 

These  memories  of  sequences']  /"Those  sequences  of  events 

are  like  r  corresponds  with  j  are  like 

This  concept  of  a  sequence   ''  I  This  sequence  of  events. 

Here  a  new  relation  is  established  between  two  groups  of 
mental  states,  each  of  them  corresponding  with  groups  of 
circumstances  that  have  not  before  been  thought  of  together. 
The  bringing  together  of  these  mental  states  is  a  process  of 
reasoning,  and  gives  rise  to  a  relation  of  likeness  between  the 
mental  states,  corresponding  to  the  relation  of  likeness  be- 
tween the  circumstances  to  Avhich  the  mental  states  refer. 

In  every  case  of  thought,  therefore,  whether  of  perception, 
remembrance,  or  reasoning,  there  is  a  correspondence  between 
the  internal  and  the  external,  between  a  relation  in  the 
organism  and  a  relation  in  the  environment.     We  have  now 


112  SANITY   AND   INSANITY. 

to  notice  that  in  thought,  as  in  feehng,  the  internal  term 
may  be  adjusted  or  unadjusted  to  the  external  term  with  which 
it  corresponds. 

This  animal,  which  on  a  casual  glance  I  perceived  to  be  a 
horse,  surprises  me  by  the  character  of  its  whinny,  and  on 
looking  at  it  again  I  see  that  it  is  not  a  horse,  but  a  mule. 
At  the  first  glance  the  precepts  of  form,  colour,  &c.,  dragged 
into  consciousness  and  cohered  with  memories  of  equine 
qualities  which  the  mule  did  not  possess.  So  that  the 
internal  relation  of  cohesion  between  presented  states  and 
remembered  states,  corresponded  to  an  external  relation 
of  ;/o;;-coexistence  between  the  group  of  qualities  presented 
and  the  group  inferred.  The  internal  relation  was  not 
adjusted  to  the  external  relation  with  which  it  corresponded. 
Graphically,  the  state  of  affairs  would  be  represented  thus — 

Mental  relation.  Environinetital  relation. 

This  group  of  presented  states'!    corresponds   [     This  group  of  quahties 
coheres  with  \   with,  but  is    j         does  Wi?/ coexist  with 

This  group  of  memories     '  unadjusted  to  vThis  other  group  of  quahties. 

It  will  be  observed  that  as  thought  is  the  correspondence  of 
internal  with  external  relations,  so,  when  thought  is  erroneous, 
it  is  the  internal  relation  alone  that  fails  to  correspond  with 
the  external.  Each  term  of  the  internal  relation,  considered 
separately,  not  only  corresponds  with,  but  is  adjusted  to,  an 
environmental  circumstance.  The  group  of  presented 
mental  states — the  ideas  of  form,  colour,  size,  distance,  &c., 
of  an  object,  are  in  correct  adjusted  correspondence  with  the 
actual  form,  colour,  size,  and  distance  of  the  object.  The 
memories  of  equine  qualities  do  correctly  represent  the 
actual  qualities  that  pertain  to  horses.  What  is  erroneous 
is  not  the  occurrence  of  these  mental  states  in  correspondence 
with  the  qualities  that  they  severally  refer  to,  but  their 
occurrence  in  that  particular  relation  of  cohesion,  repre- 
senting and  implying  a  corresponding  relation  of  co-existence, 
which  does  not  in  fact  exist,  between  the  observed  object  and 
equine  characteristics. 


WHAT    INSANITY    IS.  II3 

The  case  of  memory  does  not  need  to  be  separately  con- 
sidered, and  we  may  go  on  at  once  to  consider  how,  in  the 
case  of  reasoning,  the  internal  relation  may  fail  in  its 
adjustment  to  the  circumstances  with  which  it  corresponds. 
If,  in  reasoning  that  the  strike  of  miners  is  likely  to  result 
in  a  rise  in  the  price  of  coal,  I  omit  to  notice  that  when  a 
rise  in  prices  has  followed  previous  strikes,  the  masters  had 
conceded  an  increase  of  wages  to  the  men  ;  while  in  the 
present  case  the  men  had  struck  against  a  reduction  of 
wages,  to  which  they  had  eventually  been  obliged  to  submit  ; 
it  is  obvious  that  the  mental  relation  is  unadjusted  to  the 
external  relation  with  which  it  corresponds  ;  or,  graphically — 

Mental  relation.  Environmental  relation. 

These  memories  of  sequences]    corresponds    [Those  sequences  of  events 
are  like  \    with,  but  is    i  are  nnlike 

This  concept  of  sequence.    ■'  unadjusted  to  ^    This  sequence  of  events. 

From  the  foregoing  examination  of  Conduct,  Feeling,  and 
Thought,  it  appears  that  each  of  them  can  be  reduced  to 
the   common  terms   of  adjustment  of   the  organism  to  its 
surroundings.     Conduct  is  the  adjustment  of  the  acts  of  the 
organism  to  the  circumstances  in  which  it  is  placed.     Feeling 
is  the  adjustment  of  states  in  the  organism  to  interactions 
between  the  organism  and  its  surroundings.     Thought  is  the 
adjustment  of  relations  in  the  organism  to  relations  in  the 
surroundings.     Each  is  a  phase  or  a  factor  or  a  means  in  this 
adjustment  ;  and  hence  we  arrive  at  a  comprehensive  state- 
ment of  the  function  of  the  highest  nervous  regions,  whose 
outcome  is  Conduct,  and  whose  concomitants  are  Feeling  and 
Thought.     If  we  predicate  that  the  function  of  these  highest 
nerve  regions   is   the    adjustment    of   the    organism    to   its 
surroundings,  we  have  evidently  obtained  the  expression  of 
which  we  were  in  search,  which  will  include  and  sum  up 
disorders  of  these  highest  centres,  disorders  of  Conduct  and 
disorders  of   Mind   in    a    single  comprehensive   expression. 
They  are  all  included  and  implied  in  disorders  of  the  adjtist- 

9 


114  SANITY    AND    INSANITY. 

meiit  of  the  individual  to  his  surroundings,  or  of  the  organism 
to  its  environment. 

Although  in  thus  expressing  the  nature  of  insanity  we 
have  made  a  great  advance  upon  the  views  which  regard 
it  as  a  disorder  of  mind  only  or  of  conduct  only,  yet  the 
expression  is  not  yet  perfect,  for  in  its  present  form  it  will 
include  the  whole  category  of  mistakes,  failures,  abnormal 
sensations,  erroneous  remembrances,  and  invalid  reasonings 
which  w^e  have  already  illustrated  so  copiously.  Each  of 
these  is  in  its  own  way  a  failure — a  disorder — of  the  adjust- 
ment of  the  organism  to  its  environment  ;  and  it  therefore 
becomes  necessary  to  find  a  limitation  ot  this  expression, 
which  shall  exclude  such  failures  of  the  adjustment  as  are  of 
the  nature  of  mistakes,  and  are  consistent  with  sanity,  and 
shall  include  those  disorders  only  which  are  insane.  Such  a 
limitation  is  not  difficult  to  find. 

Here  is  a  locked  door,  and  here  is  the  key  which  should 
unlock  it.  The  attempt  to  unlock  the  door  is  made,  and 
fails.  What  are  the  possible  sources  of  failure  ?  The  defect 
may  be  in  the  key.  It  may  be  broken  ;  the  pipe  may  be 
obstructed  ;  or  the  wards  may  be  worn  away.  Or  the  defect 
may  be  in  the  lock.  The  tumbler  may  be  broken  ;  or  the 
lever  bent  ;  or  a  screw^  may  have  got  loose  and  fallen  among 
the  works  ;  or  its  parts  may  be  glued  together  by  rust.  In 
either  case,  whether  key  or  lock  is  in  fault,  the  attempt  at 
unlocking  fails.  But  there  is  a  third  source  of  possible 
failure.  The  process  of  unlocking  may  be  at  fault.  The 
key  may  be  so  inserted  in  the  lock  that  the  peg  of  the  latter, 
instead  of  running  into  the  pipe  of  the  key,  runs  alongside 
of  it.  Or  the  key  may  not  be  pushed  home,  and  so  fail  to 
turn.  Or  the  lock  may  be  a  reversed  one,  and  the  key  may 
be  turned  in  the  wrong  direction.  In  either  case,  the 
attempt  to  unlock  the  door  will  fail  ;  and  it  will  fail,  not 
because  of  any  defect  in  key  or  lock,  but  because  X}[\&  process 
of  unlocking  is  wrongly  conducted. 

What  is  true  of  this  very  simple  case  of  the  adjustment  of 
one  thing  to  another,  is  true  also  of  the  very  complex  case 


WHAT   INSANITY   IS.  II5 

of  the  adjustment  of  the  organism  to  its  environment.  The 
adjustment  may  fail  because  the  organism  is  damaged  or 
inefficient ;  or  because  the  environment  exhibits  conditions 
which  the  organism  is  not  competent  to  deal  with  ;  or,  which 
is  virtually  the  same  thing,  because  the  environmental  con- 
ditions are  imperfectly  known.  In  either  case  the  adjustment 
fails  from  fault  of  one  or  other  of  the  things  which  have  to 
be  adjusted.  It  is  either  the  lock  or  the  key  which  is  at 
fault.  But  if  the  environment  presents  no  conditions  but 
those  which  the  normal  organism  is  capable  of  coping  with  ; 
and  if  the  organism  is  physically  capable,  and  yet  fails  to 
adjust  itself  to  its  environment  ;  then  the  failure  is  due,  not 
to  the  insufficiency  or  fault  of  this  or  that  factor  in  the 
adjustment,  but  to  disorder  of  the  process  itself  of  adjust- 
^ment  ;  and  this  is  the  disorder  which  constitutes  insanity. 

If  a  man  is  deaf,  and  fails  to  hear  the  approach  of  a 
carriage,  which,  in  consequence  of  his  non-avoidance,  knocks 
him  down,  there  is  a  failure  in  the  adjustment  of  acts  to 
circumstances.  The  failure  of  the  adjustment  is  due,  how- 
ever, to  the  fault  of  the  organism.  Had  he  been  aware 
of  the  approach  of  the  carriage,  he  would  have  avoided  it, 
and  have  shown  thereby  that  X\\^  process  of  adjustment  was 
unimpaired.  In  this  case  the  defect  is  in  the  key.  Or  if 
he  is  aware  of  his  danger,  but  gets  knocked  down  and 
injured  because,  being  infirm,  he  does  not  move  quickly 
enough  to  get  out  of  the  way,  there  is  again  a  failure  of 
adjustment  of  acts  to  circumstances  ;  but  here  again  the 
failure  is  due  to  fault,  not  in  the  process  of  adjustment,  but 
in  one  of  the  factors  or  terms  that  have  to  be  adjusted. 
The  effi)rts  that  the  invalid  makes  to  get  out  of  the  way 
prove  clearly  that  \\\s,  process  is  intact.  It  is  the  organism 
that  is  at  fault.  The  defect  is  again  in  the  key.  If,  on  the 
other  hand,  his  hearing  is  normally  acute  and  his  move- 
ments sufficiently  active,  but  yet  he  fails  to  get  warning 
of  the  approach  of  the  carriage  because,  for  instance,  snow 
is  on  the  ground  and  silences  the  sound  of  its  approach,  or 
because    some   intervening   vehicle   that   he   had   to  avoid 


Il6  SANITY  AND   INSANITY. 

obstructed  his  view  and  obscured  his  warnings  of  danger, 
then,  in  such  cases,  it  is  clear  that  Avhat  is  at  fault  is  the 
condition  of  things  in  the  environment,  which  renders  it 
impossible  for  him  to  make  the  due  and  necessary  adjust- 
ment of  acts  to  ends.  The  fault  is  in  the  lock.  But  suppose 
that  none  of  these  defects  or  obstacles  are  present,  and  yet 
the  adjustment  fails.  Suppose  that  the  man  is  of  normal 
strength  and  vigour,  and  his  sight  and  hearing  are  acute  ; 
and  suppose  that  the  carriage  is  driving  towards  him  along 
a  clear  and  unobstructed  road  ;  suppose  that  neither  factor 
in  the  adjustment,  neither  organism  nor  environment,  is 
defective  or  at  fault  ;  and  suppose  that, 'notwithstanding 
these  favourable  conditions,  the  man  walks  in  the  middle 
of  the  road,  gazes  vacantly  at  the  approaching  carriage,  fails 
to  get  out  of  the  way,  and  gets  knocked  down  and  run  over. 
In  such  a  case  the  fault  is  neither  in  the  organism  nor  in 
the  environment,  neither  in  key  nor  lock.  What  is  defective 
is  \.\\Q. process  of  adjusting  the  one  to  the  other;  and  in  such 
a  case  the  condition  is  one  of  insanity. 

Or  take  a  somewhat  more  elaborate  case.  A  merchant 
has  despatched  to  him  a  telegram  stating  that  a  fleet,  laden 
with  the  commodity  in  which  he  deals,  has  been  lost  in  a 
tornado,  and  that  no  more  supplies  of  that  commodity  will 
be  forthcoming  for  a  year.  To  adjust  himself  to  this  altered 
state  of  circumstances  it  is  evident  that  he  ought  to  buy 
every  pound  of  that  commodity  that  he  can  lay  his  hands  on. 
Suppose  he  fails  to  do  this.  The  failure  may  arise  from  one 
of  three  causes.  The  telegram  may  fail  to  reach  him  ;  or, 
having  reached  him,  it  may  have  been  altered  in  trans- 
mission so  as  to  convey  the  impression  that  the  fleet  is  not 
lost  but  doubled  ;  or  the  intelligence  may  have  reached 
others  first,  and  every  scrap  of  the  merchandize  may  have 
already  been  taken  off  the  market.  In  cither  case  he  fails 
to  buy.  His  acts  are  not  adjusted  to  his  circumstances  ; 
there  is  faihire  of  adjustment  ;  but  the  cause  of  the  failure 
is  in  the  circumstances.  The  defect  is  in  the  lock,  and  no 
question  of  insanity  arises.     On  the  other  hand,  the  tele- 


WHAT   INSANITY    IS.  Il7 

gram  may  be  properly  worded,  and  may  reach  him  in  time, 
but  he  has  forgotten  the  cypher,  and  cannot  read  it  ;  or  he 
is  stricken  with  illness  and  cannot  attend  to  it.  In  such 
cases  the  failure  in  the  adjustment  is  due  to  defect  in  the 
organism.  The  fault  is  in  the  key,  and  in  such  cases  the 
question  of  insanity  does  not  arise.  But  if  he  receives  and 
reads  the  telegram  in  its  true  sense,  and  if  there  is  plenty 
of  stock  on  the  market,  and  if  he  yet  goes  into  the  market 
and  sells  a  bear,  then  it  is  manifest  that  the  fault  is  now 
neither  in  the  environment  nor  in  the  organism,  neither 
in  lock  nor  key,  but  in  Xh.^  process  of  adjustment  of  the  one 
to  the  other ;  and  now  it  is  evident  that  the  act  is  an  insane 
one. 

What  is  true  of  the  adjustment  of  the  acts  of  the  organism 
to  circumstances  in  the  environment  is  true  also  of  the 
adjustment  of  states  in  the  organism  to  interactions  between 
it  and  the  environment  ;  it  is  disorder  of  the  process  of 
adjustment  that  constitutes  insanity.  Suppose  that  a  man 
shouts  to  attract  my  attention,  and  I  fail  to  hear  him 
because  I  am  deaf ;  in  such  a  case  there  is  action  of  an  agent 
upon  the  organism  without  the  occurrence  of  a  corresponding 
feeling.  There  is  a  failure  of  adjustment  of  the  organism 
to  the  environment,  and  the  cause  of  the  failure  is  defect 
in  the  organism.  The  key  is  at  fault.  But  if  from  the 
state  of  the  atmosphere  his  voice  fails  to  reach  me,  although 
he  is  pretty  near  and  shouts  loudly,  then  again  there  is 
failure,  and  the  failure  is  due  to  defect  in  the  environment. 
The  lock  is  at  fault.  But  if  he  shouts  a  friendly  greeting 
and  I  hear  words  of  objurgation  and  abuse,  then  the  defect 
is  neither  in  organism  nor  environment,  but  in  the  process 
of  adjusting  the  state  in  the  one  to  the  action  of  the  other, 
and  then  the  defect  is  an  insane  one. 

Or  suppose  that  I  have  a  feeling  of  anger.  There  are 
four  possible  conditions  under  which  such  a  feeling  may 
arise.  The  anger  may  be  aroused  by  the  antagonistic  action 
of  some  person  towards  me  ;  and  if  the  amount  of  feeling 
is  duly  proportioned  to  the  degree  of  antagonism,  the  con- 


Il8  SANITY   AND   INSANITY. 

dition  of  things  is  perfectly  normal.  But  suppose  it  is  not 
normal.  Suppose  that  the  feeling  of  anger  is  aroused  by 
a  relation  or  attitude,  which  is  not  antagonistic,  of  some 
person  towards  me.  Then,  as  before,  there  are  three  al- 
ternatives. Although  the  action  of  the  person  towards  me 
be  not  antagonistic,  yet  I  may  have  been  brought  by  mis- 
leading appearances  and  false  reports  to  believe  that  it  is 
so.  The  impression  coming  upon  me  from  my  surroundings 
is  such  as  would  be  produced  by  antagonism  in  the  agent, 
and  hence  arises  the  corresponding  feeling  ;  the  cause  of 
the  non-adjustment  of  the  feeling  to  the  action  being  there- 
fore in  the  environment.  The  lock  is  out  of  order.  Or  the 
action  may  not  have  been  antagonistic,  but  friendly,  as, 
for  instance,  if  a  man's  housemaid  tidies  up  his  papers 
in  his  absence  ;  but  if  he  has  been  harassed  in  business, 
if  he  has  had  an  unsavoury  dinner,  and  if,  above  all, 
he  is  suffering  from  dyspepsia,  the  action  may  provoke  an 
outburst  of  anger  quite  out  of  proportion  to — unadjusted 
to — the  circumstances.  In  such  a  case  the  disproportion 
of  the  feeling  to  the  circumstances  is  ovring  to  defect  in  the 
organism.  The  individual  is  abnormally  irritable,  and 
undue  emotion  is  provoked  by  a  trifling  offence.  But  in 
such  a  case  what  happens  ?  The  next  morning,  after  a  good 
night's  rest  and  a  good  breakfast,  the  anger  has  disappeared. 
The  man  recognizes  that  it  was  in  excess  of  the  occasion  ; 
he  laughs  it  off,  and  withdraws  the  notice  of  dismissal  that 
he  had  giv^en  to  his  servant  the  night  before.  In  other 
words,  the  feeling  is  readjusted  to  the  circiufistances^  and 
this  very  readjustment  shows  that  \hQ  process  of  adjusting 
must  be  unaffected.  In  neither  of  these  cases,  in  which 
the  environment  alone,  or  the  organism  alone,  is  affected, 
does  the  question  of  insanity  arise.  But  suppose  that  the 
next  morning  the  feeling  is  not  readjusted  to  the  circum- 
stances. Suppose  that  the  anger  is  as  hot  as  ever,  and  that 
the  sentence  of  dismissal  is  confirmed.  Suppose  that  the 
servant  is  not  only  sent  away,  but  sent  away  without  a 
character,  and  that  she  is  followed  to  her  home  by  abusive 


WHAT   INSANITY    IS.  IJ^ 

letters.  Clearly  in  such  a  case  we  should  say  that  the  man 
was  mad,  and  we  should  say  so  because,  not  only  was  his 
feeling  of  anger  disproportionate — unadjusted — to  the  cir- 
cumstances in  which  it  occurred,  but  it  was  incapable  of 
readjustment.  It  did  not  cool  down  with  time  and  reflec- 
tion. And  this  incapability  of  readjustment  proves  that  the 
process  of  adjusting  feelings  to  circumstances  was  disordered. 

The  same  test  as  applies  to  conduct  and  to  feeling  deter- 
mines the  sanity  or  insanity  of  thought.  When  I  think 
that  the  bill  shown  to  me  amounts  to  13s.  6d.  instead  of 
15s.  6d.,  the  error,  as  in  the  previous  cases,  may  have  one 
of  three  sources.  It  may  be  that  my  sight  is  defective,  so 
that  I  cannot  distinguish  the  difference  between  the  figures  ; 
or  it  may  be  that  the  glance  I  gave  was  too  cursory  to  give 
me  a  clear  view  ;  in  which  cases  the  defect  is  due  to  the 
organism.  Or  it  may  be  that  the  figures  are  indistinctly 
written,  and  the  5  is  made  so  like  a  3  as  to  mislead  ;  in 
which  case  the  environment  is  at  fault.  Or  it  may  be  that 
neither  organism  nor  environment  is  defective,  but  that  the 
process  of  perception  is  wrongly  conducted.  In  the  latter 
case  the  test  of  insanity  is  the  possibility  of  rectifying  the 
error.  If  my  sight  is  good,  and  the  figures  are  clearly 
written,  and  yet  upon  attentive  examination  I  still  maintain 
that  the  amount  is  13s.  6d.,  then  there  is  only  one  explana- 
tion— I  am  suffering  under  an  illusion.  The  process  of 
adjusting  internal  relations  to  external  relations  is  disordered, 
and  the  illusion  is  outside  the  pale  of  sanity. 

As  with  perception,  so  with  memory.  If  I  remember  the 
name  of  this  flower  as  coriopsis  when,  as  a  matter  of  fact,  its 
name  is  calliopsis,  the  error  may  have  one  of  three  sources. 
It  may  be  that  my  hearing  is  defective  and  I  did  not  catch 
the  name  as  it  was  pronounced,  in  which  case  the  organism 
is  at  fault  ;  or  it  may  be  that  the  gardener  was  uncertain 
in  his  pronunciation,  and  laying  emphasis  on  the  last  two 
syllables  slurred  over  the  first  so  as  to  mislead  me,  in  which 
case  the  environment  is  at  fault.  Or  it  may  be  that  I  heard 
and  understood  distinctly  at  the  time  that  the  name  was 


I20  SANITY    AND    INSANITY. 

calliopsis,  but  that  now  the  name  is  revived  differently 
as  coriopsis,  in  which  case  there  is  a  failure  in  the  adjust- 
ment of  the  internal  relation  to  the  external  relation.  But 
if,  on  referring  to  my  authority  and  being  corrected,  I  accept 
the  right  name,  the  faulty  relation  is  readjusted,  thus 
showing  that  the  process  oi  adjustment  is  intact.  While 
if,  on  the  other  hand,  in  spite  of  the  assurances  of  the  gar- 
dener and  the  bystanders,  I  maintain  that  the  name  given 
to  me  was  coriopsis,  I  must  be  suffering  under  a  delusion. 

In  the  case  of  reasoning  the  same  lavA^  obtains.    If  I  main- 
tain that  the  strike  of  miners  must  be  followed  by  a  rise 
in  price  of  coal,  the  circumstances  of  the  strike  being  similar 
in  all  respects  to  the  circumstances  of  previous  strikes  which 
have    been    followed    by   enhanced    prices,    the    process    is 
normal,   and  if  a  rise  in  prices  actually  ensues,  it  affords 
proof  that  the  relation  between  ideas  was  properly  adjusted 
to  the  relation  between  circumstances.     But  if  I  reason  that 
the  strike  will  be  followed  by  an  advance  in  prices  when, 
as  a  matter  of  fact,  it  is  followed  by  a  fall,  there  are,  as  in 
each  of  the  other  cases,  three  possible  sources  of  error.    The 
defect  may  be  in  the  organism.     I  may  have  omitted    to 
note  that  the  strike  has  failed,  and  that  the  men  have  gone 
in  again  at  the  old  rates  ;  but  if  this  omission  is  brought 
under  my  notice,  and  I  rectify  the  error  and  so  alter  the 
internal  relation  as  to  bring  it  into  adjustment  with  external 
— if,  that  is  to  say,   I  predict,  on  getting  possession  of  this 
new  datum,  that  there  will  be  no  rise  in  prices — then  the 
process  of  adjustment  is  normally  affected,  and  so  establishes 
its  own  validity.    Or  the  defect  may  be  in  the  environment. 
The  newspaper  report   may  affirm   that  the  masters  have 
given  way  to  the  men,  when,  as  a  matter  of  fact,  the  men 
have  given  way  to  the  masters.     When,  however,  the  real 
state  of  the  case  becomes  known,  the  readjustment  is  made, 
the  prediction  altered,  and  again  the  process  of  making  the 
adjustment  is  seen  to  be  intact.    But  suppose  that  the  strike 
has  been  against  a  reduction  of  wages,  and   suppose  that  it 
has  failed,  and  the  men  have  had  to  submit  to  the  reduction  ; 


WHAT   INSANITY   IS.  121 

and  suppose  that  there  is  no  counterbalancing  circumstance 
giving  an  upward  tendency  to  prices.  If  now,  knowing 
all  this,  I  still  maintain  that,  since  other  strikes  were  fol- 
lowed by  enhanced  prices,  this  strike  must  result  in  a 
similar  rise,  it  is  manifest  that  the  limits  of  the  normal  are 
exceeded.  Even  when  in  possession  of  the  necessary  data 
I  am  unable  to  make  the  correction  necessary  to  bring  the 
internal  relation  between  ideas  into  adjustment  with  the 
external  relation  between  circumstances.  It  is  \y\.Q  process 
of  making  this  adjustment  which  is  disordered,  and  the 
defect  is  now  an  insane  one. 

Whatever  form  or  phase  we  take  of  the  adjustment  of 
the  organism  to  its  environment,  we  find  that  still  the  same 
rule  prevails.  So  long  as  a  failure  in  the  adjustment  is  due 
to  defect  in  the  organism  or  in  the  environment,  so  long 
it  amounts  merely  to  a  mistake  ;  but  if  the  failure  is  due 
to  defect  in  the  process  of  adjustment,  then  it  amounts  to 
insanity ;  and  this  is  true  whether  the  disorder  is  of  conduct, 
of  the  simpler  forms  of  feeling  known  as  sensation,  of  the 
more  complex  forms  of  feeling  known  as  emotion,  or  of  any 
of  the  three  forms  of  thought — perception,  memory,  or 
reasoning. 

If  this  be  the  true  doctrine  of  the  nature  of  insanity,  then 
it  has  certain  consequences  and  corollaries  which  have  to  be 
considered. 

Before  we  can  tell  whether  the  process  of  adjustment  is 
disordered,  we  must  first  discover  whether,  as  a  fact,  the 
adjustment  is  defective.  If  it  be  defective,  we  have  then  to 
determine  whether  the  defect  is  in  the  organism,  the  envi- 
ronment, or  the  process  of  adjustment  of  the  one  to  the 
other.  But  the  first  question  to  determine  is.  Is  there  defect 
in  the  adjustment  of  this  individual  to  his  surroundings  ? 
If  we  find  a  defect  we  may  then  go  on  to  discover  the 
source  of  it. 

To  decide  whether  a  plug  is  suited  to  fit  a  hole  we  must 
notice  the  size  and  shape  and  material  of  the  plug,  and  the 
size  and  shape  and  material  of  the  hole  also.     A  round  plug 


122  SANITY   AND   INSANITY. 

will  not  fit  a  square  hole  ;  a  brass  plug,  of  however  excellent 
workmanship,  would  not  suitably  fill  up  a  hole  in  a  silk 
dress  ;  nor  would  a  plug  of  salt  be  suitable  to  stop  up  a  hole 
in  a  cistern.  So,  too,  in  deciding  whether  a  man  is  suited 
to  a  certain  position  we  have  to  consider  not  only  the  quali- 
ties of  the  man,  but  the  requirements  of  the  position,  and 
only  when  both  have  been  considered  can  we  say  whether 
or  no  the  one  is  suited  to  the  other.  In  the  same  way  we 
cannot  determine  whether  or  no  there  is  any  defect  in  the 
adjustment  of  a  person  to  his  surroundings,  until  we  have 
examined  not  only  the  person  himself,  but  his  surroundings 
also.  Feelings,  thoughts,  and  conduct,  that  are  very  un- 
suitable to  one  set  of  surroundings,  may  be  perfectly  in 
accordance  with  the  fitness  of  another  set  ;  and  that  may  be 
sanity  in  one  set  of  circumstances  which  in  another  would 
be  insanity.  A  few  instances  will  make  the  matter  clearer. 
Suppose  that  a  man  sits  still  all  day  and  shouts  incessantly 
at  the  top  of  his  voice.  Under  ordinary  circumstances  such 
conduct  would  be  insane  ;  but  if  the  man  has  fallen  into  a 
pit  and  broken  his  leg,  such  conduct  would  be  the  best 
method  of  attracting  attention  and  leading  to  his  rescue  ;  it 
would  be  the  normal  and  proper  means  of  adapting  himself 
to  his  circumstances.  Or  take  the  case  of  a  man  who  jumps 
out  of  a  second-floor  window  into  the  street  beneath  ;  such 
an  act  is,  under  ordinary  circumstances,  unquestionably 
insane.  But  if  the  house  is  in  flames  behind  him,  and  the 
firemen  below  are  holding  a  sheet  to  catch  him,  the  act  gives 
him  the  best  chance  of  preserving  his  life.  It  is  the  normal 
and  proper  means  of  adjusting  himself  to  his  circumstances, 
and  so  is  sane  conduct.  A  man  who  is  unable  to  count 
above  five,  who  walks  about  naked,  coram popido^  adorning 
his  person  only  with  feathers  and  tawdry  ornaments,  would 
ordinarily  be  called  insane  ;  but  if  he  has  a  black  skin,  and 
lives  on  the  banks  of  the  Congo,  he  is  considered  an  average 
specimen  of  normal  humanity.  These  are  extreme  cases, 
but  the  necessity  of  taking  account  of  a  man's  surroundings 
before   pronouncing    him    insane   is   equally  imperative    in 


WHAT    INSANITY    IS.  123 

every  case  that  comes  before  us.  In  corroboration  of  this 
view,  which  I  advanced  in  the  Journal  of  Mental  Science 
some  years  ago,  Dr.  Wilks,  upon  seeing  the  article,  recorded 
the  following  cases  : — 

"  A  gentleman,  holding  a  good  position  in  a  Government 
office,  broke  down  in  health,  and  his  medical  man  sought 
the  advice  of  two  or  three  physicians  as  to  the  line  of  treat- 
ment which  should  be  pursued.  The  consultants  were 
informed  by  his  attendant  that,  according  to  the  patient's 
own  view  of  his  case,  it  was  not  so  much  office  work  as 
domestic  anxiety  and  worry  which  had  crushed  him  ;  for  he 
had  long  suspected  the  unfaithfulness  of  his  wife,  and  had 
even  seen  gentlemen  in  his  house.  This  statement  his 
medical  attendant  regarded  as  a  sad  exposition  of  the 
patient's  mental  condition,  and  in  consequence  looked  on 
him  as  bordering  on  insanity.  This  view  the  consultants 
accepted,  as  they  were  informed  that  all  the  gentleman's 
suspicions  were  groundless.  He  was  sent  away  into  the 
country  and  was  ordered  to  be  rigidly  watched.  He  did  not 
live  long,  and  after  his  death  it  came  out  most  unmistakably 
that  his  wife  had  been  unfaithful  to  him,  and  that  gentle- 
men had  been  admitted  even  into  her  husband's  house." 

"  In  a  case  which  some  time  aoro  came  before  a  leo-al 
tribunal,  in  which  there  was  reasonable  question  of  insanity, 
one  witness  in  favour  of  insanity  candidly  told  me  that  he 
at  once  assented  to  the  proposition  when  he  was  a  witness 
of  ^the  unusual  circumstances  in  which  the  patient  was 
placed,  which  were  these  : — He  was  a  gentleman  of  good 
position  and  fortune,  lodging  in  an  obscure  part  of  London, 
unknown  to  his  family,  his  only  acquaintance  being  those 
belonging  to  the  house  in  which  he  lived.  The  whole 
procedure  was  so  unnatural  and  unusual  that,  when  his 
children  discovered  him,  there  was  no  difficulty  in  getting 
him  pronounced  insane.  A  friend  of  the  gentleman,  how- 
ever, who  knew  him  well,  was  most  indignant  at  the  impu- 
tation, and  afforded  an  explanation  of  his  conduct  by  saying 
that  his  wife  was  dead,  his  daughter  had  run  away,  and  his 


124  SANITY    AND    INSANITY. 

two  sons  were  so  impoYerishing  him  by  calls  upon  his  purse, 
that  he  had  no  other  resource  than  to  escape  and  hide  him- 
self, in  order  to  avoid  these  importunities." 

"  Another  case  was  that  of  a  gentleman  who  was  pro- 
nounced insane  by  myself  and  four  other  medical  men.  The 
patient  Avas  living  in  the  suburbs  of  London,  and  had  long 
been  known  to  me  by  name  and  by  sight.  He  lived  in  a 
detached  house,  with  a  large  garden,  having  carriages  and 
servants  and  all  the  appurtenances  of  a  well-to-do  man. 
He  was  reported  as  being  very  rich.  I  was  asked  one  day 
to  visit  him  professionally.  I  met  two  medical  men,  general 
practitioners  in  the  neighbourhood,  who  informed  me  that 
for  some  weeks  he  had  taken  to  his  bed,  refused  food,  had 
grown  very  thin,  had  sleepless  nights,  and  declared  that  he 
should  not  live  until  Christmas.  My  visit  w^as  in  the 
autumn.  He  had  fallen,  they  said,  into  a  state  of  melan- 
choly, and  was  suffering  from  fearful  delusions  ;  he  was 
constantly  talking  of  his  wickedness,  of  the  dreadful  future 
which  awaited  him  hereafter,  should  he  by  any  possibility 
escape  a  felon's  doom  in  this  world.  He  was  constantly 
asking  if  the  police  had  arrived  to  lodge  him  in  gaol.  I 
then  went  upstairs  to  see  him,  and  after  condoling  with  him 
and  expressing  my  regret  to  see  him  in  this  unhappy  state 
of  mind,  suggested  what  could  be  done  to  turn  his  thoughts 
into  a  happier  channel.  He  answered  that  it  was  of  no  use 
talking  to  him,  that  he  should  not  live  long,  that  he  never 
knew  when  morning  broke  Avhether  before  night  he  would 
not  be  in  prison.  In  this  way  he  continued  to  talk,  reason- 
ing was  of  no  avail,  and  so  I  left  him.  Two  other  physicians 
had  pronounced  the  case  to  be  one  of  melancholia.  We 
inquired  carefully  of  his  wife  as  to  any  circumstances  which 
might  have  thrown  him  into  this  distressing  state  of  mind, 
but  could  hear  of  none.  A  few  weeks  afterwards  a  relative 
of  his  called  upon  and  informed  me  that  the  patient  had 
been  trustee  for  some  orphans,  that  he  had  for  many  years 
been  appropriating  the  funds  to  himself,  and  that  when  the 
time  arrived  when  he  knew  that  the  crash   must  come,  he 


WHAT    INSANITY   IS.  12$ 

broke  down,  being  perfectly  unable  to  meet  the  shock,  took 
to  his  bed,  and  fell  into  a  state  of  despair.  He  had  been 
guilty  of  gross  frauds,  and  every  word  he  said  about  his  own 
wickedness  was  correct,  and  it  was  only  too  true  that  at  any 
moment  the  police  might  have  entered  his  house  and  carried 
him  off  to  gaol,  where  he  would  have  spent  his  remaining 
years  in  infamy.  To  save  this  disgrace  an  arrangement  was 
made  to  refund  the  purloined  money  as  far  as  possible,  and 
when  this  was  settled  he  left  his  bed,  and  lived  nearly  three 
years  afterwards." 

The  second  corollary  that  follows  from  the  doctrine  that 
insanity  is  a  disorder   of  the  process  of  adjustment  of  the 
organism  to  the  environment,  is  this,  that  where  there  is  a 
failure  in  the  adjustment  the  test  of  sanity  is  the  corrigihility 
of  the  defect.     If  the  process  of  adjustment  is  not  disordered 
the  want  of  adjustment  will  be  recognized,  and  attempts  at  re- 
adjustment made,  and  if  neither  organism  nor  environment  be 
at  fault  the  readjustment  will  be  effected,  and  the  organism 
again  be  brought  into  harmony  with  its  circumstances  ;  but 
if  the  process  be  disordered,  the  lack  of  adjustment  will  not 
be  recognized,  and  then  no  attempt  at  readjustment  is  made, 
or  if  made  is  unsuccessful.     The  truth  of  this  proposition  has 
already  been  incidentally  illustrated  in  the  previous  pages,  but 
its  importance  demands   some  further   notice.     A  feeling  of 
anger  is,  as  has  been  said,  the  normal  state  that  arises  in  the 
organism  upon  cognizance  of  an  antagonistic  agent  in  the 
environment.     Suppose,  for   instance,  that   an    Irish   land- 
agent,  after  a   scene  with  some  of  his  tenants,   has  stones 
thrown  into  his  window,  and  sees  the  defaulting  tenant  out- 
side.    He  experiences  a  feeling  of  anger,  which  is  the  natural 
and  normal  result  of  the  action.     In  the  evening,  as  he  is 
sitting    writing,   he   again   hears    stone    after   stone  thrown 
against  his  window,  and  the  feeling  of  anger  revives  and  is 
intensified.     Examination  is  made,  however,  and  it  is  found 
that  the  noise  attributed  to  the  striking  of  stones  against 
the  window  is  really  due  to  the  knocking  against  it  of  the 
branch  of  a  tree  swayed   by  the  wind.     Now  to  bring  the 


126  SANITY   AND   INSANITY. 

organism  into  adjustment  with  the  circumstances  the  feeHng 
of  anger  against  the  tenant  should  disappear.  If  it  does  so, 
well  and  good.  But  suppose  that  it  does  not,  suppose  that 
it  remains  at  height  in  spite  of  this  discovery,  then  the  feel- 
ing— the  state  in  the  organism — is  unadjusted  to  the  circum- 
stances. If,  however,  upon  second  thoughts,  and  on  the  remon- 
strance of  friends,  the  man  can  be  made  to  see  that  his  anger 
is  unreasonable,  and  to  suppress  it,  the  failure  in  adjustment 
is  corrected,  the  process  of  adjustment,  at  first  lacking,  is 
re-established,  and  the  question  of  sanity  does  not  arise. 
But  if,  in  spite  of  clearest  demonstration,  he  retains  his 
anger  against  the  tenant  because  of  the  tapping  of  the 
branch  of  the  tree  against  the  window,  the  matter  has  clearly 
gone  beyond  the  domain  of  sanity. 

Again,  if  a  woman,  as  in  the  case  of  Mrs.  A ,  sees  a 

spectral  cat,  and  recognizes  that  the  appearance  has  no  corres- 
ponding substance  in  the  environment,  although  perception  is 
disordered,  insomuch  that  she  sees  a  cat  where  no  cat  exists, 
yet  the  fact  that  she  can  connect  this  perception  by  appeal  to 
experience,  and  so  bring  her  inner  conviction  that  there  is 
no  cat,  into  adjustment  to  the  outer  circumstance  that  no 
cat  is  there,  proves  that  the  process  of  producing  adjustment 
is  unaffected,  and  establishes  her  sanity.  If,  however,  she 
actually  believes  that  the  spectral  cat  is  real,  and  cannot  be 
convinced  by  tactual  experience  that  no  cat  is  there,  the 
inability  to  correct  the  hallucination  proves  her  to  be 
insane. 

If  a  man  of  wealth  and  substance  takes  it  into  his  head 
that  he  is  miserably  poor,  that  he  has  no  right  to  his 
splendid  house  and  fine  equipages,  and  that  his  inevitable 
destination  is  the  workhouse,  his  friends  will  probably  try 
to  convince  him  of  his  error  by  affording  him  proofs  of  the 
prosperity  of  his  affairs.  They  will  take  him  to  his  bank 
and  get  the  manager  to  certify  to  his  balance  there.  He 
will  reply  that  however  great  his  balance,  it  is  nothing  to 
his  liabilities.  They  will  enumerate  his  investments  and 
point  out   their    stability    and    remunerativeness.      To    no 


WHAT   INSANITY   IS.  1 27 

purpose  ;  he  replies  that  they  are  but  a  drop  in  the  ocean  of 
his  responsibihties.  They  take  him  to  his  counting-house, 
get  an  accountant  to  examine  his  books  and  certify  to  his 
complete  solvency  and  sound  position.  Again  to  no 
purpose.  The  actuary  is  incompetent  ;  the  books  are 
falsified  ;  accountant,  friends,  partners  and  clerks  are  in  a 
conspiracy  to  deceive  and  befool  him.  Since  the  J>i'ocess  of 
adjustment  of  himself  to  his  surroundings  is  disordered,  he 
cannot  correct  his  false  opinions,  and  the  incorrigibility  of 
his  opinions  constitutes  them  delusions. 

Hence  we  see  the  futility  of  attempting  to  argue  an 
insane  person  out  of  his  delusions.  If  they  were  removable 
by  argument  they  would  not  be  delusions.  It  is  because 
the  process  of  correcting  opinions,  and  bringing  them  into 
accordance  with  circumstances,  is  disordered,  that  he  holds 
the  delusions  ;  and  so  long  as  this  process  is  disordered,  it 
matters  not  how  clearly  the  circumstances  may  be  presented, 
the  adjustment  is  still  impossible.  If  the  lack  or  failure  of 
adjustment  were  due  to  the  want  of  definiteness  of  the 
circumstances,  if,  in  short,  it  were  the  environmental  factor 
in  the  adjustment  that  were  at  fault,  then  the  case  would  be 
different  ;  then  the  clarifying  and  defining  of  this  term 
would  restore  the  adjustment  to  the  normal  ;  but  since  the 
defect  is  in  Xhe  process^  no  improvement  in  the  terms  is  any 
help.  It  is  no  use  oiling  the  lock  if  the  key  is  still  turned 
the  wrong  way. 

It  is  the  same  with  conduct.  Insane  conduct  cannot  be 
corrected.  Here  is  a  patient  who  is  possessed  by  a  puck- 
like spirit  of  mischief.  He  cannot  refrain  from  burning, 
breaking,  destroying  or  throwing  away  everything  that  he 
can  get  into  his  possession.  The  one  thing  that  he  is  passion- 
ately fond  of  is  smoking.  Yet  he  will  smash  a  new  pipe  into 
fragments,  well  knowing  that  he  thereby  deprives  himself 
for  several  days  of  his  favourite  pursuit.  He  is  vain  of  his 
appearance,  and  was  delighted  at  being  given  a  new 
umbrella  ;  but  on  his  way  home  he  dropped  behind  to 
throw  it  over  a  hedge  without  being  seen.     No  amount  of 


128  SANITY   AND    INSANITY. 

punishment  that  might  be  inflicted  on  him  would  correct 
these  habits,  and  their  incorrigibiHty  constitutes  their 
insanity.  Understand,  it  is  not  said  that  the  habits  cannot 
be  ctired.  Cure  the  insanity  and  you  do  away  with  the 
conduct.  But  so  long  as  the  insanity  exists,  so  long  no 
motive  that  can  be  held  out  to  him  will  induce  him  to 
abandon  the  conduct.  Here,  again,  is  a  man  of  boundless 
wealth  and  generous  disposition,  who  cannot  dine  at  a 
friend's  house  without  stealing  the  spoons.  The  value  of 
the  spoons  is  nothing  to  him.  The  disgrace  of  discovery 
would  overwhelm  him  and  his  family  with  shame  and  con- 
sternation. A  man  of  acute  intellect  and  sound  judgment, 
no  one  could  appreciate  more  fully  than  he  the  consequences 
of  his  conduct  ;  yet  he  cannot  correct  it. 

It  is  not  said  that  the  conduct  of  the  insane  cannot  be 
influenced  by  the  ordinary  motives  of  reward  and  punish- 
ment which  influence  and  regulate  the  conduct  of  the  sane. 
Unquestionably  it  can.     But  the  conduct  of  the  insane  is 
not  necessarily  insane  conduct.     Most  insane  persons  have  a 
large  sphere  of  conduct   in   which   they  are  comparatively, 
perhaps  absolutely,  sane  ;  and  this  portion  of  their  conduct 
is  regulated  in  the  same  way  as  that  of  sane  people.     Only 
the  insane  portion  of  their  conduct  is  incorrigible  ;  and  so 
long  and  so  far  as  they  are  insane,  the  incorrigibility  of  this 
portion  of  their  conduct  is  absolute.      In  one  ward  of  an 
asylum  of  which  I  had  charge  there  used  to  occur  a  number 
of  unaccountable  black  eyes.      The    attendants   were   fre- 
quently cautioned,  and   frequently  changed,    and   yet    the 
black   eyes   occurred,    and    were    usually   found    on    those 
patients  who  were  too  feeble  to  protect  themselves  and  too 
demented  to  give  an  account  of  how  they  received  them. 
At  length  among  the  admissions  was  a  little  quiet  under- 
sized Irishman,  who  was  placed  in  this  ward,  and  the  next 
day  a  patient,  G.  S.,  who  had  been  zealous  in  endeavouring 
to  discover  the  source  of  the  black  eyes,  received  from  the 
new  admission  a  tremendous  thrashing.      His  explanation 
was    that    the    attack    was   unprovoked,   but   the  Irishman 


WHAT   INSANITY   IS.  1 29 

asserted  that  G.  S.  had  hit  him  in  the  eye,  and  he,  being  an 
ex-pugihst  and  a  former  hght- weight  champion,  had 
promptly  retahated.  The  result  was,  that  from  that  day  no 
more  black  eyes  appeared  in  that  ward.  There  was  no 
doubt  that  the  source  of  them  was  G.  S.,  and  the  fact  that 
they  ceased  after  he  had  been  punished  proved  that,  in  this 
respect,  his  conduct  was  not  insane,  but  was  merely  the 
gratification  of  the  bullying  and  savage  instincts  of  a  low 
and  brutal  nature.  No  amount  of  punishment  would  alter 
the  really  insane  portion  of  his  conduct. 

In  this  distinction  between   sane  and  insane  conduct,  as 
apart  from  the  sanity  or   insanity    of   the    actor,  we   have 
evidently  the  key  to  the  employment  of  punishment  in  the 
discipline  of  asylums.     There  are  some  who  say,   and  say 
with  justice,  that  it  is  as  cruel  and  unreasonable  to  punish  a 
lunatic  as  to  punish  a  person  for  his  dreams.     On  the  other 
hand,   those    who   have  practical  experience  of  the  insane, 
know  that  in  maintaining  discipline  among  them  punish- 
ment is  frequently  employed,   and  is  frequently   effectual. 
The  discrepancy  is  reconciled  when  we  remember  that  the 
conduct  of  insane  persons  is  not  all  insane.     It  may  be  that 
only  the  highest  and  most  elaborate  and  most  difficult  of 
the  adjustments  to  surroundings   are  disordered,  while  all 
adjustments   of  inferior  rank  are  normally  carried  out,  and 
the  process  of  effecting  them  intact.    In  such  a  case  punish- 
ment  would  be  effectual  in  restraining  conduct  in  all  its 
lower  divisions,  while  its  higher  manifestations   would    be 
totally  uninfluenced.     These  cases,  in  which  only  the  very 
topmost  strata  of  nervous  arrangements  are  touched  by  dis- 
order, are  just  those  which  produce  the  greatest  bewilder- 
ment in  the  minds  of  the  laity,  who  hold  on  the  one  hand 
that  it   is  wrong  to  detain  such  cases  in  asylums,  and  on 
the    other    that    they    are    cases    in    which    punishment    is 
imperatively  called  for.     It  is   easy  to  understand  that   in 
insanity,    that    is    with    disorder    of    the    highest    nervous 
arrangements,  the  very  lowest  nervous  arrangements  may 
be  unaffected,  and  that,  for  instance,  the  movements  of  the 

10 


130  SANITY   AND   INSANITY. 

heart  and  those  of  breathing  may  be  perfectly  well  per- 
formed ;  that  the  middle  layers  of  nervous  arrangements 
may  be  healthy,  that  the  limbs  may  be  unparalyzed  and  the 
movements  of  walking  and  of  handicraft  normally  and 
efficiently  performed  ;  all  this  is  readily  recognized  and 
admitted.  But  it  is  by  no  means  so  easy  to  grasp  the  fact 
that  all  the  subsidiary  nervous  functions  up  to  those  im- 
mediately beneath  the  very  highest  may  be  normally  and 
well  performed,  while  the  highest  arrangements  of  all  are 
completely  out  of  gear  and  inefficient.  An  insane  person 
may  not  only  be  in  vigorous  physical  health,  may  not  only 
have  his  purely  vegetative  functions,  worked  by  the  lowest 
nervous  arrangements,  in  good  order  ;  may  not  only  be  an 
efficient  artizan,  a  skilful  billiard  or  cricket  player,  that  is, 
may  not  only  have  his  middle  nervous  arrangements  working 
efficiently  ;  but  he  may  be  an  amusing  and  intelligent  com- 
panion, be  able  to  conduct  himself  well  in  society,  may  be 
able  to  transact  business,  and  to  perform  passably  well  the 
elevated  mental  operations  required  in  the  exercise  of  an 
intellectual  profession  ;  but  for  all  that,  his  highest  processes 
of  all  may  be  disordered,  and  he  may,  in  a  limited  but  com- 
plicated sphere  of  action,  be  insane.  He  may  be  able  to 
conduct  successfully  the  erection  of  a  church,  but  yet  be 
unable  to  conduct  himself  towards  his  wife  and  family  as  a 
sane  man.  Such  cases  are  a  perennial  source  of  wonder  to 
the  laity,  but  it  is  evident  upon  reflection  that  it  is  not 
more  wonderful  that  there  may  be  disorder  of  the  highest 
nervous  arrangements  without  disorder  of  those  immediately 
below  them,  than  that  it  may  exist  without  disorder  of 
those  considerably  below  them. 

Out  of  the  observation  that  the  disorder  in  insanity  may 
be  limited  to  a  thin  stratum  at  the  top  of  the  nervous 
arrangements,  and  therefore  to  a  small  but  elevated  part  of 
the  whole  sphere  of  conduct,  has  arisen  a  common  and  silly 
saying  that  all  people  are  insane  on  some  point.  The  argu- 
ment seems  to  be  that  since  in  some  cases  of  insanity  the  dis- 
order is  limited  to  but  a  small  portion  of  conduct,  feeling,  and 


WHAT   INSANITY   IS.  131 

thought,  therefore  in  every  person  there  is  some  small 
portion  which  is  disordered  :  an  argument  which,  when 
stated  in  plain  terms,  is  seen  to  be  an  absurd  non  seqiiitur. 
The  facts  that  every  one  makes  mistakes,  that  every  one 
fails  sometimes  in  effecting  perfect  adjustment  of  himself 
to  his  circumstances  in  the  general  domains  of  thought, 
feeling,  and  conduct,  either  from  carelessness,  or  from  defect 
in  organism,  or  from  difiiculty  in  circumstances,  has  nothing 
to  do  with  the  question.  It  is  as  absurd  to  say  that  every 
one  is  insane  ''  on  some  point  "as  to  say  that  every  one's 
digestion  is  disordered  on  some  point.  No  doubt  there  are 
for  every  man  circumstances  to  which  he  cannot  adjust  him- 
self, just  as  there  are  for  every  man  things  which  he  cannot 
digest  ;  but  the  fact  that  he  cannot  adjust  himself  to  his 
circumstances  is  of  itself  no  more  a  proof  of  insanity  than 
the  fact  that  he  cannot  digest  tenpenny  nails  is  of  itself  a 
proof  of  disordered  digestion.  Such  a  saying  is  like  that  of 
Fabatus,  who  held  that  seafaring  men  are  all  mad.  "  The 
ship  is  mad,  for  it  never  stands  still  ;  the  mariners  are  mad 
to  expose  themselves  to  such  imminent  dangers  ;  the  waters 
are  raging  mad,  in  perpetual  motion  ;  the  winds  are  as  mad 
as  the  rest — they  know  not  whence  they  come  nor  whither 
they  go  ;  and  those  are  maddest  of  all  that  go  to  sea  ;  for 
one  fool  at  home  they  find  forty  abroad."  "  He  was  a  mad- 
man that  said  it,  and  thou  peradventure  as  mad  to  read  it." 
Nevertheless,  in  this,  as  in  most  sayings  that  have  ob- 
tained a  wide  prevalence,  there  is  a  glimmering  of  truth  ; 
and  the  truth  which  it  seeks  to  express  is,  not  that  every  one 
is  insane  "  on  some  point  " — by  which  I  presume  is  meant  to 
some  extent — but  that  every  one  is  insane  at  some  time. 
This  last  proposition,  if  not  absolutely  true,  is  very  nearly  so. 
There  are  times  in  the  lives  of  all  of  us  when  thoughts  are 
experienced,  when  feelings  are  felt,  when  acts  are  done,  that 
can  only  be  accounted  for  as  due  to  temporary  derangement. 
On  some  of  these  occasions  we  are  not  aware  of  any  special 
cause  for  the  disorder  of  the  highest  nervous  centres  which 
we  experience  ;    on   others   the   cause   is  apparent  and  the 


132  SANITY    AND    INSANITY. 

existence  of  the  disorder  unquestionable.  Such  occasions 
are  those  of  intoxication  with  alcohol,  ether,  chloroform, 
opium,  and  other  drugs  ;  such  are  the  occurrence  of  delirium 
in  fevers  and  other  forms  of  blood-poisoning,  in  starvation, 
in  haemorrhage,  &c.  ;  such  are  the  disorders,  often  trivial, 
sometimes  grave,  of  conduct  and  mind  which  occur  in  great 
fatigue,  after  prolonged  sleeplessness,  &c.  Few  persons  live 
to  maturity  without  the  occurrence  of  some  one  or  other  of 
these  occasions  in  the  course  of  their  lives,  and  consequently 
of  few  persons  can  it  be  said  that  throughout  the  whole  of 
their  lives  they  were  perfectly  sane  ;  but  as  stated  thus,  the 
proposition  that  every  one  has  his  insane  moments  becomes 
at  once  intelligible  and  probable,  which  cannot  be  said  of 
the  proposition  for  which  it  has  been  substituted. 

There  is  yet  another  corollary  that  may  be  drawn  from 
the  doctrine  of  the  nature  of  insanity  as  here  stated.  If 
insanity  be  a  disorder  of  the  process  of  adjustment  of  the 
organism  to  its  environment,  or  of  self  to  surroundings,  and 
if  this  disorder  may  be  limited  to  a  thin  stratum  at  the  top 
of  the  nervous  arrangements,  then  it  follows  that  although  a 
person  may  be  insane  so  long  as  he  is  in  surroundings  of 
such  complexity  as  to  demand  the  use  of  his  highest  faculties — 
that  is,  of  those  which  are  disordered — yet,  if  he  be  placed  in 
an  environment  of  simpler  character,  in  which  no  call  is 
made  for  the  exercise  of  his  highest  faculties,  but  all  the 
requirements  of  his  simpler  surroundings  can  be  met  by  the 
exercise  of  his  less  elevated  faculties,  to  which  the  disorder 
has  not  extended,  then  to  that  simpler  environment  he  is 
able  to  adjust  himself,  and  in  those  simpler  surroundings  he 
is  virtually  not  insane.  To  a  stranger  going  for  the  first 
time  through  a  large  lunatic  asylum,  the  most  astonishing 
circumstance  is  the  apparent  sanity  of  a  large  proportion  of 
its  inmates.  And  the  sanity  is  in  many  cases  more  than 
apparent  ;  it  is  real,  so  long  as  the  individual  is  retained  in 
those  simple  surroundings.  Having  proved  himself  unable 
to  perform  the  necessary  adjustments  required  by  the  larger 
surroundings  of  the  outside  world,  he  is  here  provided  with 


WHAT    INSANITY    IS.  133 

a  set  of  surroundings  to  which  Httle  effort  on  his  part  is 
needed  to  adjust  himself,  for  they  are  already  artificially 
adjusted  to  him. 

The  burden  and  stress  of  earning  his  living,  temptation 
to  drink,  opportunities  for  immorality,  incitements  to  theft, 
provocations  to  rage,  he  is  here  carefully  shielded  from,  and 
no  call  being  made  upon  his  highest  faculties,  which  alone 
are  disordered,  no  insanity  shows  itself.  No  opportunity 
being  given  him  to  further  extend  the  deteriorative  process 
by  drink  and  other  means,  it  remains  at  its  high  level,  and 
the  lower  and  simpler  processes,  which  alone  he  now  needs, 
remain  intact.  But  send  this  tranquil,  orderly,  sedate 
individual  out  into  the  world  again,  and  in  a  fortnight  he 
will  come  back  to  the  asylum,  a  raving  maniac. 

So  far  we  have  arrived  at  two  definite  conclusions  with 
regard  to  the  nature  of  insanity : — i.  That  it  is  a  disorder  of 
the  adjustment  of  self  to  surroundings ;  and — 2.  That  the  seat 
of  the  physical  disorder  is  in  the  highest  nerve  arrangements, 
whose  function  it  is  to  effect  this  adjustment.  It  will  be 
remembered  that  the  circulation  of  energy  in  the  nervous 
system  has  been  described  as  twofold  ;  that  there  is  a  minor 
circulation  of  energy  to  and  fro  between  the  brain  and  the 
viscera,  and  a  major  circulation  to  and  fro  from  the  sense- 
organs  to  the  brain,  and  from  the  brain  back  to  the  muscles. 
Furthermore,  it  has  been  shown  that  the  central  or  cerebral 
portion  of  the  one  circulation  has  for  its  mental  accompani- 
ment the  consciousness  of  self,  and  that  the  central  portion 
of  the  other  has  for  its  mental  accompaniment  the  conscious- 
ness of  surroundings.  Hence  it  will  appear  that  in  the  highest 
nervous  arrangements,  in  the  supreme  strata  of  the  nervous 
system,  in  which  self  is  brought  into  relation  Avith  surround- 
ings, factors  of  both  these  circulations  are  present.  There 
the  most  highly  elaborated  streams  of  energy,  proceeding 
from  the  visceral  and  nutritive  processes,  are  received,  and 
the  most  highly  elaborated  discharges  for  the  regulation  of 
these  processes  are  initiated.  There,  too,  are  received  the 
currents   from    eye,    ear,    nose,    tongue,    palate,   and    skin  ; 


134  SANITY    AND    INSANITY. 

and  there  are  originated  the  currents  to  the  muscles  by 
which  movements  are  made  in  adaptation  to  impressions 
from  without.  But  these  two  sets  of  processes  must  not  be 
regarded  as  carried  on  separately.  The  function  of  the 
highest  nerve-regions  we  have  seen  to  be  the  adjustment  of 
self  to  surroundings.  In  them,  therefore,  not  only  are 
represented  the  actions  of  surroundings  and  the  reactions 
upon  surroundings,  but  self  also  is  represented,  and  is 
brought  into  relation  with  these  actions  and  reactions. 

When  there  is  disorder  of  these  highest  nervous  arrange- 
ments, there  is  disorder  of  the  central  portion  of  the  major 
circulation  of  nerve  energy.  The  impressions  received  from 
the  eye,  ear,  &c.,  are  received  and  responded  to  by  muscular 
movements,  but  they  are  wrongly  received  or  wrongly 
responded  to,  or  both.  There  is  disorder  of  the  adjustment 
of  one  to  the  other.  Similiarly,  when  these  highest  arrange- 
ments are  disordered,  there  is  disorder  also  of  the  central 
portion  of  the  minor  circulation  of  nerve  energy.  The 
impressions  arriving  from  the  viscera,  and  from  the  nutritive 
processes  at  large,  are  received  and  are  responded  to  by  the 
emission  of  regulating  streams  of  energy,  but  they  are 
wrongly  received,  or  wrongly  responded  to,  or  both.  Hence 
it  happens  that,  whenever  the  highest  nervous  arrange- 
ments are  disordered,  not  only  is  there  disorder  of  conduct 
and  disorder  of  that  part  of  consciousness  which  corresponds 
with  conduct,  but  there  is  also  disorder  of  the  visceral  and 
nutritive  processes  throughout  the  body,  and  there  is 
disorder  of  the  other  moiety  of  consciousness — the  conscious- 
ness of  self — which  is  the  mental  reflection  of  these  processes. 

In  every  case  of  insanity  the  nutrition  of  the  whole  body 
is  disordered  ;  it  may  be  that  the  disorder  is  but  slight  and 
inconspicuous,  but  disorder  more  or  less  there  always  is. 
Since  any  disorder  in  the  nutrition  of  the  internal  parts  of 
the  body  would  not  be  directly  observable,  and,  moreover, 
would  not  always  be  of  sufficient  magnitude  to  affect  function 
conspicuously,  and  so  enable  us  to  estimate  it,  it  is  to  the 
exterior  of  the  body — to  the  skin  and  its  appendages — that 


WHAT   INSANITY   IS.  135 

we  usually  have  to  look  for  evidence  of  nutritive  disorder  in 
insanity  ;  and  here  it  is  usually  conspicuous  enough  to  be 
discovered.  There  is,  as  might  be  expected,  a  parallelism 
between  the  insanity  and  the  disorder  of  the  skin.  In  mild 
and  slight  cases  of  insanity  the  disorder  is  inconspicuous  ; 
in  chronic  and  severe  cases  it  is  usually  very  marked.  The 
skin  is  dry  and  harsh,  the  hair  staring  and  refractory,  the 
nails  ridged  and  furrowed  ;  or  the  skin  is  unduly  moist  and 
sweaty,  the  epidermis  is  shed  abundantly,  the  odour  is  often 
strong  and  extremely  offensive.  The  colour  of  the  skin  is 
often  altered,  and  becomes  dusky  and  earthy.  The  alteration 
of  hair  and  nails  is  often  extreme  and  peculiar.  I  have 
known  the  nails  on  both  fingers  and  toes  to  be  actually  shed 
after  an  attack  of  acute  mania  ;  and  the  harsh,  bristling, 
erect  condition  of  the  hair  often  causes  it  to  assume  extra- 
ordinary positions,  and  to  impart  a  weird  and  impressive 
character  to  the  face.  Eminent  alienists — Dr.  Hack  Tuke, 
and  Sir  James  Crichton  Browne — have  remarked  alternations 
of  the  state,  and  even  of  the  colour,  of  the  hair,  corresponding 
to  alternations  in  the  mental  condition.  These  alterations  in 
the  colour  of  the  hair  and  skin  in  insanity  may  usefully  be 
compared  with  the  alterations  that  take  place  in  violent 
emotions  ;  the  cause — a  disturbance  in  the  highest  nervous 
centres — being  the  same  in  both.  In  the  latter  class  of  cases 
the  disturbance,  though  transitory,  is  usually  more  sudden 
and  intense,  and  hence  the  changes  that  it  produces  are 
more  conspicuous.  The  familiar  observation  of  the  hair 
turning  grey  in  grief  and  in  great  anxiety  is  a  case  in  point. 
Doubts  are  sometimes  expressed  as  to  the  accuracy  of  this 
observation,  but  there  are  cases  on  record  which  place  it 
beyond  a  doubt.  Numerous  cases  have  been  recorded  of  the 
hair  turning  grey  in  a  single  night,  but  the  following,  related 
by  Staff-Surgeon  D.  P.  Parry,  is  even  more  remarkable. 
"On  February  19,  1858,  a  prisoner  in  the  S.  of  Oude  was 
brought  before  the  authorities  for  examination.  Divested  of 
his  uniform,  and  stripped  completely  naked,  he  was 
surrounded    by  soldiers,  and  then   first  apparently  became 


136  SANITY   AND   INSANITY. 

alive  to  the  dangers  of  his  position.     He  trembled  violently, 
intense  horror  and  despair  were  depicted  on  his  countenance, 
and,  although  he  answered  the  questions  addressed  to  him, 
he  seemed  almost  stupefied  with  fear  ;    while  actually  under 
observation,  within  the  space  of  half-an-hour,  his  hair  became 
grey    on   every  portion  of   his  head,  it  having  been,  Avhen 
;first  seen  by  us,  the  glossy  jet  black  of  the  Bengalee,  aged 
about     24.      The    attention    of    the    bystanders    was    first 
attracted  by  the  sergeant,  whose  prisoner  he  was,  exclaiming, 
'  He  is  turning  grey  !  '  and  I,  with  several  persons,  watched 
the  process.      Gradually,  but  decidedly,  the  change  went  on, 
and    a    uniform   greyish   colour  was  completed  within  the 
period  named."     It  is  interesting  to  note  that  not  the  hair 
only,  but  the  skin  also  may  change  colour  as  the  result  of  a 
violent  nerve  storm,  accompanied  by  a  violent  emotion.     In 
Xh-Q  Journal  Encylopediqiie  is  related  the  case  of  a  man  who 
had,  after    being   very   angry,  an    apoplectic    attack,  which 
ended  in  paralysis  of  the  right  side,  and  at  the  same  time 
this  side  of  his  body  became  completely  yellow,  not  except- 
ing even  the  right  half  of  his  nose.     During  the  first  French 
Revolution    a    woman    was    condemned    to    death    by   the 
Parisian  mob,  and  the  lantern  (the  instrument  of  execution) 
was    actually  let    down    at    her   feet.      She  was   reprieved, 
however.     Shortly  afterward  her  colour  began  to  change, 
and  in  a  few  days  she  became  as  dark  as  a  moderately  dark 
negro.     She  died  in  1819,  aged  seventy-five,  more  than  thirty 
years  after,  her  skin  remaining  dark  until  her  death.    Laycock 
relates  the  case  of  a  young  lady,  aged  sixteen,  who  met  a  man 
in  the  dark  who  insulted  and  greatly  terrified  her.     In  the 
morning   her   eyelids  were   yellow.     The   colour  gradually 
extended  for  eight  days,  until  her  face  was  covered  ;  then 
the  yellow  deepened  into  black.      Eight  days  afterwards  the 
arms  began  to  turn  yellow,  and  became  slowly  black.     The 
colour  remained  for  four  months,  at  the  end  of  which  time 
she  rapidly  recovered. 

In  1 76 1  a  Parisian  lady  of  high  rank  (a  duchess)  suffered 
much  anxiety  and  grief,  two  of  her  children  dying  while 


WHAT    INSANITY    IS.  137 

her  husband  was  away  at  the  wars.  After  excessive  weeping 
her  eyehds  became  discoloured,  as  if  painted  black,  and  this 
colour  extended  over  the  cheeks  in  patches.  She  recovered, 
and  some  time  after  her  remaining  child  fell  ill.  Her  fore- 
head then  became  reddish  brown,  and  finally  quite  black, 
the  colour  extending  gradually  until  the  whole  face  was 
black.     Eventually  the  colour  disappeared. 

From  these  examples  it  is  evident  that  every  commotion 
in  the  highest  nerve-regions  has  an  effect  upon  nutrition, 
and  that  in  some  cases  the  effect  of  such  a  commotion  is 
very  conspicuous.  We  have  next  to  notice  the  comple- 
mentary facts,  that  every  disorder  of  the  lesser  or  visceral 
circulation  of  nerve-energy,  involves  an  alteration  in  the 
consciousness  of  self,  and  that,  while  a  local  disorder  in  the 
peripheral  portion  of  the  circulation  involves  but  a  slight 
alteration  in  the  self-consciousness,  the  alteration  of  con- 
sciousness becomes  more  pronounced  and  more  decided  the 
more  widespread  the  disorder  of  the  visceral  circulation,  and 
the  more  nearly  the  disorder  invades  the  highest  nerve- 
regions. 

When  the  entire  visceral  circulation  is  affected  by  an 
increase  or  a  diminution  of  the  tension  of  the  nerve-energy, 
then  of  course  the  section  of  the  circulation  included  in  the 
highest  nerve-regions  is  similarly  and  continuously  affected  ; 
and  under  such  circumstances  the  feeling  of  well-being  is 
heightened  or  lowered  in  proportion  to  the  increase  or 
diminution  of  the  nerve-tension.  When  this  alteration  of 
tension  of  the  nerve-energy  is  unaccompanied  by  disorder 
of  the  highest  nerve-regions,  there  is  simple  alteration  of 
the  sense  of  well-being,  without  other  alteration  of  mind. 
The  individual  feels  happy  or  miserable  without  the  occur- 
rence of  external  changes  to  make  him  so,  and  without 
being  able  to  account  for  the  feeling.  When  the  portion 
of  the  highest  nerve-regions  which  directly  receives  and 
redistributes  these  visceral  currents  is  disordered,  then  there 
is  disorder  of  the  appreciation  of  self.  The  self-conscious- 
ness   is    altered.      The    individual    believes    himself    to   be 


138  SANITY    AND   INSANITY. 

different,  to  be  possessed,  to  be  dead,  to  be  unnatural,  to  be 
double,  and  so  forth.  This  disorder  of  the  appreciation  of 
self  may  be  accompanied  by  either  heightened  or  diminished 
tension  of  nerve-energy,  and  therefore  by  feelings  either  of 
satisfaction  or  of  misery.  The  function  of  the  highest 
nerve-regions,  it  will  be  remembered,  is  not  merely  the 
representation  of  self,  but  the  adjustment  of  self  to  surround- 
ings ;  and  hence,  when  these  highest  centres  are  disordered, 
it  can  but  rarely  happen — it  is  scarcely  possible — that  the 
disorder  can  be  so  localized  as  to  be  limited  to  the  appre- 
ciation of  self.  When  the  appreciation  of  self  is  disordered, 
there  is  always  some  amount  of  mal-adjustment  of  self  to 
surroundings  ;  so  that  when  a  man  believes  himself  to  be 
different,  or  unnatural,  or  dead,  these  disorders,  referring 
primarily  to  the  appreciation  of  self,  are  always  accompanied 
by  disorder  of  conduct  of  some  extent. 

Thus  we  arrive  at  last  at  a  complete  statement  of  the 
nature  of  insanity.  Insanity,  we  find,  is  a  disorder  of  the 
adjustment  of  self  to  surroundings.  This  adjustment  of 
self  to  surroundings  is  effected  by  the  highest  of  all  the 
nervous  arrangements,  and  the  central  and  primary  factor 
in  insanity  is  the  disorder  of  these  arrangements.  De- 
pendent on  this  central  disorder  are  other  disorders  : — i . 
Conduct,  which  it  is  the  function  of  the  highest  nervous 
arrangements  to  actuate,  is  disordered  ;  and — 2.  Conscious- 
ness, which  accompanies  the  working  of  the  highest  nervous 
arrangements,  is  disordered.  Regarded  in  one  light,  accord- 
ing as  it  accompanies  discharges  from  cells  or  currents  in 
fibres,  consciousness  is  divisible  into  feelings  and  thoughts  ; 
and  according  as  discharges  in  cells  or  currents  in  fibres  are 
mainly  affected,  the  disorder  is  mainly  disorder  of  feeling  or 
disorder  of  thought.  Regarded  in  another  light,  according 
as  it  accompanies  activity  of  that  portion  of  the  highest 
nervous  arrangements  which  is  the  supreme  development  of 
the  visceral  circulation  of  nerve-energy,  or  as  it  accompanies 
that  portion  which  is  the  supreme  development  of  the 
major    or    sense-muscle   circulation    of    nerve-energy,    con- 


WHAT    INSANITY    IS.  139 

sciousness  is  divisible  into  consciousness  of  self  and  con- 
sciousness of  the  relation  of  self  to  surroundings  ;  and 
according  as  the  one  or  the  other  region  of  the  highest 
nervous  arrangements  is  mainly  affected,  the  disorder  is 
mainly  disorder  of  the  consciousness  of  self,  or  disorder  of 
the  consciousness  of  the  relation  of  self  to  surroundings. 

In  every  case  of  insanity  there  are  present  all  the  three 
factors — disorder  of  the  highest  nerve  arrangements,  disorder 
of  conduct,  and  disorder  of  consciousness  ;  and  in  every 
case  the  disorder  of  consciousness  includes  disorder  of 
thought  and  of  feeling,  of  self-consciousness  and  of  con- 
sciousness of  the  relation  of  self  to  surroundings.  In  no 
two  cases,  however,  are  these  various  factors  combined  in 
quite  the  same  way,  and  thus  no  two  cases  precisely  re- 
semble one  another.  On  the  way  in  which  they  are  com- 
bined depends  the  form  which  the  insanity  assumes. 


CHAPTER   V. 

THE    CAUSES   OF    INSANITY. 

Heredity. 

Insanity  is,  in  mathematical  terms,  a  function  of  two 
variables.  That  is  to  say,  there  are  two  factors,  and  only 
two,  in  its  causation  ;  and  these  factors  are  complementary. 
Both  enter  into  the  causation  of  every  case  of  insanity,  and 
the  stronger  the  influence  of  one  factor,  the  less  of  the 
other  factor  is  needed  to  produce  the  result.  These  two 
factors  are,  in  brief,  heredity  and  stress.  It  has  been 
explained  that,  in  order  to  work  efficiently,  the  nervous 
system  should  have  in  a  high  degree  a  certain  form  of 
instability — an  instability  which  allows  of  ready  and  free 
rearrangement  of  the  atoms  of  its  molecules,  with  easy  and 
copious  liberation  of  the  energy  accumulated  in  them.  So 
long  as  this  rearrangement  proceeds  without  actual  de- 
composition of  the  molecule,  the  process  remains  within  the 
limits  of  the  normal  ;  but  it  is  easy  to  see  that  this  form  of 
instability  has  a  certain  relationship  to  another  form — a 
form  in  which  the  disturbance  of  the  molecules  does  not 
stop  short  at  rearrangement,  but  goes  on  to  partial  or  even 
to  total  'decomposition.  Since  a  certain  degree  of  instability 
of  the  first  form  is  an  essential  to  nervous  action,  and 
necessarily  exists  in  every  possessor  of  a  nervous  system, 
and  since  this  form  of  instability  is  related,  more  or  less 
closely,  to  the  second  form,  it  is  obvious  that  some  ten- 
dency  to   the    second   form   of   instability   exists  in    every 


THE    CAUSES    OF    INSANITY.  I4I 

individual.  The  amount  or  strength  of  the  tendency  varies 
with  each  individual,  but  in  every  one  it  exists  to  some 
degree. 

It  is  manifest  that  the  amount  of  disturbance  that  is 
necessary  to  upset  any  orderly  arrangement  depends  entirely 
on  the  stability  of  the  arrangement.  When  the  component 
parts  of  a  structure  are  firmly  compacted  together,  a  violent 
disturbance  will  be  necessary  to  upset  or  disintegrate  the 
structure  ;  and  when  the  cohesion  between  the  component 
parts  is  but  feeble,  the  structure  will  be  liable  to  dis- 
integration from  disturbances  of  a  much  less  pronounced 
and  less  violent  character.  A  jerry-built  villa  is  liable  to 
be  blown  down  by  a  storm  of  wind,  but  nothing  short  of 
an  earthquake  will  destroy  a  well-constructed  mansion. 

Now  insanity  is  a  disorder  of  the  highest  nervous  centres  ; 
that  is  to  say,  a  derangement  of  the  structure  of  these 
centres,  and  this  derangement  of  structure  will  be  produced 
by  slight  disturbances  where  the  structure  is  loosely  com- 
pacted and  the  instability  great  ;  while  in  cases  in  which 
the  structure  is  well  and  soundl)^  constituted  and  of  firm 
stability,  it  will  require  a  violent  disturbance  to  upset 
its  equilibrium.  Hence  we  find  that,  according  to  the 
opening  statement,  insanity  is  a  function  of  two  variables. 
It  needs  for  its  production  a  certain  instability  of  nerve- 
tissue,  and  the  incidence  of  a  certain  disturbance.  When 
the  instability  of  tissue  is  great,  a  small  disturbance  wall 
suffice.  When  the  instability  is  small,  a  violent  disturbance 
is  necessary.  But  for  every  individual,  as  for  every  wooden 
beam,  there  is  a  breaking-point.  If  you  load  a  beam  with 
sufficient  Aveight,  a  certain  weight  will  be  found,  varying 
with  the  strength  of  the  beam,  at  which  the  beam  will 
break  ;  and  if  you  subject  a  man  to  stress,  a  certain  stress 
will  be  found,  varying  with  the  stability  of  his  nervous 
s^^stem,  at  which  the  man  will  become  insane.  Hence,  to 
determine  the  causes  of  insanity,  we  have  to  find,  first  the 
factors  which  tend  to  initial  stability  or  instability  of  the 
highest  nervous  arrangements  ;  and,  second,  the  nature  and 


142  SANITY    AND    INSANITY. 

severity  of   the  stresses   to  which    these  arrangements   are 
subject. 

The  fact  that  the  majority  of  people  do  not  become,  or 
do  not  remain,  insane,  indicates  that  they  possess  a  nervous 
organization  of  sufficient  stabihty  to  withstand  such  stresses 
as  they  are  subject  to.  And  the  minority  who  become  or 
remain  insane,  are  endowed  with  a  nervous  organization 
which  is  either  more  easily  upset,  or  is  subject  to  stress  of 
greater  severity.  As  a  matter  of  fact  the  factor  which  is 
chiefly  and  most  often  at  fault  is  the  nervous  organization. 
Although,  as  has  been  said,  there  is  an  intensity  of  stress 
which  will  permanently  upset  even  the  most  stably  con- 
stituted nervous  system,  yet  stresses  of  this  extreme  severity 
are  so  rare  in  human  experience,  that  in  practice  a  person 
of  normal  and  average  nervous  constitution  will  not  be 
driven  mad  by  any  of  the  ordinary  vicissitudes  of  life.  And 
since,  in  the  vast  majority  of  cases  of  insanity,  v/e  find  that 
the  occasion  of  the  disorder  was  some  stress  of  but  medium 
intensity,  we  may  be  quite  sure  that  in,  all  such  cases  the 
important  factor  in  the  production  of  the  insanity  is  not 
the  magnitude  of  the  disturbance,  but  the  fragihty  of  the 
arrangements  on  which  the  disturbance  breaks. 

The  stability  or  instability  of  a  person's  highest  nervous 
arrangements  depends  primarily  and  chiefly  upon  inherit- 
ance. Every  man  is  the  outcome  and  the  product  of  his 
ancestry  ;  and  this  is  true  not  only  of  the  broad  and  funda- 
mental characters  by  which  he  is  animal,  by  which  he  is 
human,  by  which  he  is  national,  by  which  he  betrays  the 
country  and  the  family  from  which  he  proceeds  ;  but  extends 
to  the  trivial  and  minutely  trivial  characters  by  which  he  is 
distinguished  from  other  individuals  of  his  own  race, 
country,  and  family.  Doubtless  every  man  is  to  some 
extent  moulded  into  conformity  with  cirumstances  by  the 
influence  of  circumstances  upon  him  ;  but  the  small  amount 
of  new  character  that  circumstances  can  produce  in  any 
individual,  in  comparison  with  the  characters  transmitted  to 
him  by  his  ancestry,  may  be  gathered  from  the  length  of 


THE    CAUSES    OF    INSANITY.  1 43 

time  that  circumstances  can  act  upon  him,  in  comparison 
with  the  aggregate  length  of  time  during  which  the  long 
line  of  his  ancestry  have  been  subject  to  modification  by- 
circumstances.  Doubtless  if  we  take  a  seedling  plant,  and 
if,  while  it  is  young,  and  its  tissues  plastic,  and  its  potenti- 
alities undeveloped,  we  subject  it  to  certain  conditions  of 
life,  we  can  modify  the  arrangement  and  alter  the  stability 
of  its  most  elaborate  and  highly-organized  parts — of  its 
flowers  and  fruit  ;  and  doubtless,  also,  if  we  subject  a  child 
to  certain  conditions  of  life,  we  may  in  the  same  w^ay 
modify  the  arrangement  and  alter  the  stability  of  its  most 
elaborate  and  most  highly-organized  parts — of  its  highest 
nervous  centres  ;  but  the  fact  remains  that,  for  the  great 
majority  of  people,  the  question  of  the  stability  or  instability 
of  their  highest  nervous  arrangements  resolves  itself  into  a 
question  of  the  kind  and  degree  of  organization  that  they 
have  inherited  from  their  ancestry.  To  ascertain,  then, 
the  influence  of  the  first  factor  in  the  production  of  in- 
sanity, it  will  be  necessary  to  give  a  brief  account  of  the 
laws  of  heredity. 

The  laws  of  heredity  are  two  :  the  Law  of  Inheritance, 
and  the  Law  of  Sanguinity.  Both  of  them  are  important 
in  connection  with  the  causation  of  insanity. 

The  Law  of  Inheritance  is  simple,  and  is  easily  stated 
and  understood.  It  is  that  the  ofspring  tend  to  inherit 
every  attribtLte  of  the  parents^  or  that  every  attribute  of  the 
parents  tends  to  appear  in  the  offspring,  and  will  appear 
unless  some  counteracting  influence  prevents.  Doubtless 
there  are  many  cases  in  which  attributes  of  the  parents  fail 
to  appear  in  the  offspring,  but  these  are  not  exceptions  to 
the  law.  The  laws  of  nature  know  of  no  exception,  and 
when  apparent  exceptions  occur,  it  is  either  because  the  laws 
are  acting  in  ways  not  understood,  or  because  of  the  inter- 
ference and  counteraction  of  other  laws.  The  rising  of  a 
balloon  is  not  an  exception  to  the  law  of  gravity,  it  is  an 
illustration  of  the  law  acting  in  an  unusual  way. 


144  SANITY   AND   INSANITY. 

That  the  law   is  true   of  the  general  and  broad  outlines 
of  structure  and  function  h  ;universally  accepted — is,  indeed, 
a  truism.     Men  do  not  gather  grapes  of  thorns,  nor  figs  of 
thistles.     "  That  wheat  produces  wheat — that  existing  oxen 
have  descended  from   ancestral  oxen — that  every  unfolding 
organism    eventually   takes    the   form    of    the    class,    order, 
genus,  and  species  from  which  it  sprang,  is  a  fact  which,  by 
force   of  repetition,  has  acquired  in  our   minds    almost   the 
aspect  of  necessity.''     But  that  the  same  law  is  true  of  the 
smaller    attributes,    down    to    the    most   trivial    details    of 
structure  and  function,  is  not  so  generally  admitted,  and  is 
even   widely   disbelieved.     Every  now   and  then,   however, 
we  meet  with  conspicuous  instances  of  the  operation  of  the 
law    in    matters   of  small  moment,   which  serve  to  fix  our 
attention,  and  demonstrate   the  constancy    of  its   working. 
Peculiarities    in   gait,   in   gesture,  and   general  bearing,  are 
often    inherited  ;  a    case    in    point    being    that   in   which   a 
father  had  the  trick  of  sleeping  on  the  back  with  the  right 
leg   crossed   over   the   left,   and  whose  daughter,   while  an 
infant  in  the  cradle,  assumed  the  same  attitude  in  sleep.     It 
is  notorious  also  that  there  are  family  similarities  in  hand- 
writing as   strong  and  as  frequent  as  family  similarities  of 
features  ;  and  this  is  the  more  important  from  the  present 
point  of  view,  since  a  peculiarity  of   handwriting  depends 
upon    an    arrangement    of    nerve-tissue   that   must   be    ex- 
tremely delicate,  extremely  elaborate,  subtle,  slight,  diffused, 
and    yet    precise.       In   comparison  with   such  a    quality  of 
nervous  arrangements,  the  peculiarity  of  tissue  organization 
which  underlies  insanity  is  gross  indeed  ;  and  hence  if  the 
one  is  transmissible  by   inheritance   we  may  be  quite  sure 
that  the  other  may  be.     That  the  children  of  insane  parents 
are  apt  to  inherit  a  tendency  to  insanity  is  what  might  be 
expected,  and  is  a    well-established  fact  ;   the    existence  of 
insanity  in  other  members  of  the  family  being  ascertained 
to    exist    is     more   than  twenty   per  cent,    of  the    patients 
admitted    into    asylums    in    this    country.      But    this   direct 
inheritance   of  insanity   is    by    no  means  the   only   way  in 


THE    CAUSES    OF    INSANITY.  I45 

which  the  first  law  of  heredity  influences  the  tendency  to 
insanity.  What  is  inherited  from  an  insane  person  is  not 
insanity  itself,  it  is  an  undue  instability  of  nervous  organi- 
zation ;  and  hence,  whenever  there  is  undue  instability  of 
nervous  organization  in  the  progenitors,  there  will  be 
liability  to  insanity  in  the  offspring.^ 

Thus,  among  the  most  conspicuous  instances  and  evi- 
dences of  undue  instability  of  organization  of  the  higher 
nervous  centres,  is  epilepsy.  Epilepsy  is  a  sudden  and 
excessive  discharge  of  nerve  elements,  beginning  usually  in 
the  highest  regions  ;  and  the  undue  and  abnormal  instability 
of  nerve  elements,  which  epilepsy  displays,  may  be  trans- 
mitted by  inheritance  to  the  offspring.  But  in  the  offspring 
this  instability  may  not  exhibit  itself  as  epilepsy.  It  may 
be  that,  instead  of  a  liability  to  sudden  and  excessive  dis- 
charges, there  is  a  liability  to  excessive  and  disorderly 
discharges  of  much  more  gradual  character,  and  the  same 
essential  defect  which  in  the  parent  caused  epilepsy  may 
in  the  offspring  underlie  insanity.  The  links  between 
epilepsy  and  insanity  form,  in  fact,  a  continuous  chain,  as 
will  be  shown  hereafter,  and  the  peculiarities  of  brain-tissue 
which  underlie  them  are  allied.  In  the  same  way  the 
hysterical  parent  may  have  children  who  become  insane, 
the  nervous  organization  which  allows  of  the  one  disturbance 
being  virtually  the  same  as  that  which  allows  of  the  other. 
So  with  people  who  are  highly  eccentric,  extremely  passion- 
ate, or  who  give  other  evidence  of  defect  in  the  organization 
of  the  highest  nervous  arrangements.  Such  defects  are  so 
nearly  allied  to  that  which  underlies  insanity,  that  it  is  as 
natural  for  the  parents  who  show  one  of  these  defects  to 
have  children  who  exhibit  another,  as  it  is  for  a  piebald 
rabbit  to  have  offspring  whose  piebald  markings  are  of 
diff"erent  shape  and  extent  from  those  of  the  parent. 

^  By  liability  to  insanity  is  here  meant  liability  to  become  insane  under 
the  operation  of  stresses,  such  as  would  not  produce  insanity  in  the  average 
or  normal  man.  As  has  already  been  shown,  every  one  is  liable  to  become 
insane  on  the  incidence  of  a  stress  that  is  sufficiently  severe. 

II 


146  SANITY    AND    INSANITY. 

While,  however,  the  existence  of  instabihty  in  the  highest 
nervous  arrangements  of  the  parents  undoubtedly  facilitates^ 
or,  more  accurately,  increases  the  chances  of,  the  occurrence 
of  insanity  in  the  offspring,  it  by  no  means  necessarily  follows 
that  the  children  of  such  parents  will  become  insane  ;  nor, 
on  the  other  hand,  are  the  children  of  those,  whose  nervous 
arrangements  are  of  normal  stability,  by  any  means  exempt 
from  developing  such  a  character  of  nervous  tissue  as  may  in- 
volve their  breakdown  into  insanity  under  the  strain  of  ordi- 
nary circumstances.  The  reasons  of  these  exceptions  to  the 
operation  of  direct  inheritance  from  parent  to  child  we 
have  now  to  discover,  and  they  will  be  found  in  those 
influences  which  have  already  been  alluded  to  as  interfering 
with  or  modifying  the  first  law  of  heredity.  Briefly  stated, 
these  influences  are  as  follow  : — 

An  attribute  which  appeared  in  the  parent  at  a  certain 
time  of  life  tends  to  appear  in  the  offspring  at  a  correspond- 
ing time  of  life.  The  successive  stages  in  the  development 
of  every  organism  present  abundant  instances  of  this  rule. 
The  embryo  resembles  the  embryo  of  the  parent  at  a 
corresponding  age,  and  the  successive  characters  assumed 
at  successive  stages  appear  at  the  same  age  in  the  new 
being  as  in  the  old.  Thus  the  caterpillar  emerges  from 
the  egg,  undergoes  repeated  moults,  changes  into  a  chrysalis, 
and  then  into  a  moth  ;  and  each  of  these  changes  occurs 
at  an  age  corresponding  with  that  at  which  it  appeared  in 
the  parents.  Similarly  the  youth  finds  his  voice  breaking 
and  his  moustache  budding  at  about  the  same  age  at  which 
the  same  changes  took  place  in  his  father  ;  and  later  on 
he  grows  stout,  his  hair  turns  grey,  his  skin  becomes 
wrinkled,  and  his  gait  shambling  at  ages  corresponding  with 
those  in  which  the  same  changes  appeared  in  his  parents. 
The  same  rule  holds  good  with  attributes  which  appear 
de  novo  in  the  parents.  In  the  family  of  Le  Compte  blind- 
ness was  inherited  through  three  generations,  and  no  less 
than  twenty-seven  children  and  grandchildren  were  all 
affected  at  about  the  same  age.     This  rule  is  true  also  of 


THE    CAUSES    OF    INSANITY.  147 

insanity,  and  many  cases  have  been  recorded.  Piorry 
tells  of  a  family  every  member  of  which  became  insane 
at  the  age  of  forty.  Esquirol  relates  a  case  in  which  the 
grandfather,  father,  and  son  all  committed  suicide  when  in 
or  near  their  fiftieth  year.  Dr.  Savage  says  he  has  known 
several  instances  in  which  the  family  inheritance  was  a 
tendency  to  pass  into  weak-mindedness  with  melancholy  at 
a  certain  period  of  life.  This  principle  may  evidently 
account  for  some  instances  of  absence  of  insanity  in  the 
children  of  insane  persons.  They  may  not  arrive  at  the 
time  of  life  at  which  the  insanity  would  have  occurred. 

W/ie?!  the  same  attribute  appears  in  several  generations^ 
hilt  is  not  congenital  {that  is ^  present  at  birth),  it  may  appear 
at  an  earlier  age  in  each  successive  generation.  For  instance, 
gout  is  rarely  met  with  under  thirty  years  of  age,  except  in 
hereditary  cases  ;  and  the  stronger  the  hereditary  tendency 
to  gout,  the  more  generations  of  gouty  ancestors  he  has  had, 
the  earlier  in  life  is  he  liable  to  the  disease.  The  same  is 
true  of  cancer,  of  goitre,  and  of  some  other  maladies  ;  thus 
in  one  family  the  grandmother  became  blind  at  thirty-five, 
her  daughter  at  nineteen,  and  three  grandchildren  at 
thirteen  and  eleven.  Cases  have  been  recorded  showing 
a  similar  advance  in  the  inheritance  of  insanity,  and  it 
is  obvious  that  where  such  an  advance  takes  place  the 
insanity  is  becoming  more  and  more  strongly  established 
in  that  stock  with  each  successive  generation.  On  the 
other  hand,  in  any  case  in  which  the  insanity  appeared 
at  a  later  age  in  successive  generations,  it  might  be  fairly 
argued  that  the  disease  was  dying  out. 

Attributes  pertaining  to  one  parent  [especially  those  appear- 
ing late  in  life^  when  the  reproductive  function  is  active)  tend 
to  be  reproduced  in  the  offspring  of  that  sex  only.  Thus 
universally  the  secondary  sexual  characters,  the  beard,  the 
more  massive  frame,  the  deeper  voice,  are  transmitted  from 
the  male  parent  to  the  male  offspring  ;  while  the  smooth 
features,  the  smaller  bones  and  muscles,  the  shriller  voice, 
the  large  breasts  and  long  hair  are  transmitted  from  mother 


148  SANITY   AND   INSANITY. 

to  daughter  only.  Besides  these  trite  instances  there  are 
many  others.  The  hsemorrhagic  diathesis  is  often  trans- 
mitted to  males  alone.  In  some  families  the  tendency  to 
bleed  is  so  strong  that  scarcely  a  single  male  arrives  at 
maturity,  while  the  females  are  not  at  all  affected.  In  the 
Lambert  family,  known  as  the  "  porcupine  men,"  the  skin 
disease  was  transmitted  to  four  generations,  and  was  strictly 
limited  to  the  male  sex,  seven  sisters  in  one  of  these  genera- 
tions being  free.  Colour-blindness  is  much  commoner  in 
males  than  in  females,  but  in  one  instance,  in  w^hich  it  first 
appeared  in  a  fem.ale,  it  was  transmitted  through  five 
generations  to  thirteen  individuals,  every  one  of  whom  was 
a  female.  The  influence  of  this  principle  also  will  evidently 
account  for  the  absence  of  insanity  in  some  members  of 
families,  the  offspring  of  a  sane  and  insane  parent. 

Curiously  enough,  the  opposite  of  the  last  proposition 
is  also  true,  and  sometimes  attributes  pertaining  to  one 
parent  are  transmitted  to  the  offspring  of  the  opposite  sex 
only  ;  a  further  explanation  of  the  non-inheritance  of 
insanity.  A  remarkable  instance  will  be  given  further  on, 
under  the  head  of  Reversion,  as  occurring  in  the  hsemor- 
rhagic diathesis. 

AttrihiLtes  peculiar  to  one  parent  max  be  most  apparent 
at  one  period  of  the  life  of  the  offsprings  and  those  of  the  other 
at  another.  Girou  states  that  calves,  the  offspring  of  a  red 
and  a  black  parent,  are  not  unfrequently  born  red,  and 
subsequently  become  black.  Darwin  crossed  several  white 
hens  with  a  black  cock,  and  many  of  the  chickens  were 
during  the  first  year  perfectly  white,  but  acquired  during  the 
second  year  black  feathers  ;  on  the  other  hand,  some  of 
the  chickens  which  at  first  were  black  became  in  the  second 
year  piebald  with  white.  The  operation  of  this  influence 
may  explain  the  occurrence  of  outbreaks  of  insanity  that 
are  apparently  causeless. 

From  the  possession  by  the  offspring  of  one  attribute 
peculiar  to  one  parent^  we  may  infer  the  possession  of  other 
attributes  peculiar  to  the  same  parent.     Thus,  I  crossed  an 


THE    CAUSES    OF    LXSANITY.  1 49 

albino  mouse  with  a  common  brown  mouse.  Of  a  litter 
of  six,  two  were  albinoes  and  inherited,  with  the  colouring, 
the  tameness  and  gentleness  of  the  mother,  while  the  other 
four  inherited  from  the  father,  not  only  their  brown  colour, 
but  their  activity  and  untameable  wildness  of  disposition. 
Moreau,  indeed,  asserts,  but  as  it  seems  to  me  on  entirely 
insufficient  evidence,  that  in  the  case  of  inherited  insanity, 
the  facial  characters  tend  to  be  inherited  from  the  p;irent 
from  whom  the  insanity  was  not  derived.  Sedgwick  says 
that  "  there  is  a  definite  connection  between  the  develop- 
ment of  the  ear  and  the  different  forms  of  insanity,  and 
both  the  form  of  the  ear  and  the  insanity  may  be  hereditary.'^ 

Latency  and  Reversion.  Among  the  most  remarkable 
of  the  many  remarkable  occurrences  of  heredity  are  the 
complementary  phenomena  known  as  Latency  and  Rever- 
sion. When  an  attribute  exists  in  an  individual,  is  absent 
in  his  offspring,  and  reappears  in  the  third  or  some  sub- 
sequent generation,  it  is  said  to  be  latent  in  those  genera- 
tions in  which  it  does  not  appear  ;  and  the  individual  in 
whom  it  at  length  appears  is  said  to  revert^  in  so  far  as 
that  attribute  is  concerned,  to  the  ancestor  in  whom  it  was 
present. 

For  instance,  a  grandfather  has  six  digits  on  each  hand  ; 
his  children  are  normally  constituted,  but  his  grandchildren 
have,  like  himself,  supernumerary  digits.  In  such  a  case  the 
grandchildren  are  said  to  revert  to  the  grandfather,  and 
the  attribute  of  possessing  supernumerary  digits  is  said  tO' 
be  latent  in  the  intermediate  generation.  Instances  of 
latency  and  reversion  are  very  common  in  every  class  of 
organisms.  The  following  highly  characteristic  examples 
are  given  by  Darwin  :  "A  pointer  bitch  produced  seven 
puppies  ;  four  were  marked  with  blue  and  white,  which  is 
so  unusual  a  colour  with  pointers  that  she  was  thought  to 
have  played  false  with  one  of  the  greyhounds,  and  the 
whole  litter  was  condemned  ;  but  the  gamekeeper  was  per- 
mitted to  preserve  one  as  a  curiosity.  Two  years  afterwards 
a  frien  d  of  the  owner  saw  the  young  dog,  and  declared  that 


150  SANITY    AND    INSANITY. 

he  was  the  image  of  his  old  pointer  bitch  Sappho,  the  only 
blue  and  white  pointer  of  pure  descent  he  had  ever  seen. 
This  led  to  close  inquiry,  and  it  was  proved  that  he  was  the 
great-great-grandson  of  Sappho.''  In  another  instance  a 
calf  reproduced  accurately  the  very  peculiar  markings  and 
colouring  of  its  great-great-great-great-grandmother,  all  the 
intervening  generations  having  been  black. 

In  the  human  race  instances  of  reversion  in  peculiar 
attributes  are  not  easily  proved,  for  the  obvious  reason  that 
we  have  not  the  same  facilities  for  observing  a  number  of 
generations,  but  reversion  is  certainly  active.  It  is  seen  in 
the  inheritance  from  the  maternal  grandfather  of  diseases 
peculiar  to  the  male  sex.  For  instance,  it  is  common  in  the 
transmission  of  the  haemorrhagic  diathesis  for  the  children 
of  the  affected  individual  to  escape  altogether  ;  all  the 
children  of  the  sons  and  the  female  children  of  the  daughters 
also  escape  ;  but  the  sons  of  the  daughters  are  affected.  A 
very  striking  instance  of  reversion  of  both  physical  and 
mental  characteristics,  and  one  evidently  reproduced  from 
experience,  is  described  by  Hawthorne  in  "  The  House  with 
the  Seven  Gables." 

Reversion  is  seen,  not  only  in  the  transmission  of  isolated 
and  peculiar  attributes,  but  in  the  re-assumption,  after  a 
longer  or  shorter  series  of  generations  in  which  the  race 
has  been  modified,  of  the  aggregate  of  general  characters 
exhibited  by  the  original  race  before  the  modification  took 
place.  For  instance,  the  domestic  pig  may,  and  does  under 
certain  circumstances,  revert  to  the  characters  of  the  wild 
boar  ;  the  highly  modified  and  specialized  breeds  of  the 
domestic  fowl  may  revert  to,  and  assume  the  characters  of, 
the  ancestral  galliis  hankiva^  the  wild  form  from  whence 
they  all  originally  descended  ;  the  offspring  of  the  grotesque 
fancy  pigeons  may  father  themselves  on  the  blue  rock,  the 
remote  wild  ancestor  of  all  the  domestic  pigeons. 

Since  all  the  other  peculiarities  of  working  of  the  principle 
of  inheritance  display  themselves  as  well  in  the  human  race 
as  in  lower  organisms,  it  is  natural  to  expect  this  peculiarity 


THE   CAUSES   OF    INSANITY.  If  I 

also  to  appear  among  men,  and  there  is  no  doubt  that  it 
■does  so.  It  is  not  merely  that  we  find  occasionally  a  man 
who  manifests  the  ungovernable  ferocity,  and  the  delight  in 
inflicting  suffering  for  the  mere  gratification  of  experiencing 
the  emotion  of  power  while  so  doing,  which  he  derives, 
after  the  intervention  of  many  generations  of  milder  minds, 
from  his  raptorial  ancestors  ;  but  that,  after  some  temporary 
■deviation,  there  is  a  return  to  conformity  with  the  general 
type  of  organization  of  the  race.  The  tendency  for  the 
developing  organism  to  unfold  after  one  particular  manner 
and  in  conformity  with  one  general  type,  has  been  fixed  by 
transmission  through  so  many  generations,  has  required 
such  force  of  momentum  in  its  long  descent,  that  the 
perhaps  local  and  temporary  influences  which  produced  in 
the  parent  a  deviation  from  the  type,  are  overborne  in  the 
offspring  by  the  steady,  enduring,  massive  pressure  of  its 
race-heredity.  The  whole  weight  of  race-heredity  comes 
down  upon  the  developing  organism,  and  forces  it  with 
irresistible  stress  into  the  old  grooves  and  channels  of 
development,  despite  the  nearer  but  feebler  influence  of 
immediate  parentage,  which  tends  to  divert  it  into  some 
new  direction.  Thus,  when  a  gardener  has  with  utmost 
pains  and  skill  produced  a  new  variety,  of  plant-form, 
he  is  often  exasperated  to  find  that  in  spite  of  all  his 
exertions,  a  portion,  a  large  proportion,  the  majority,  it  may 
be  the  whole  of  his  seedlings  will  revert  to  the  original 
form  from  which  he  bred  ;  and  that,  if  he  would  perpetuate 
his  stock,  he  must  do  so  by  layers,  or  grafts,  or  cuttings. 
The  accumulated  momentum  of  the  developmental  forces, 
descending  through  many  generations,  bears  down  all  oppo- 
sition to  their  progress  in  the  wonted  direction.  Although 
the  newly-acquired  qualities  may  be  for  a  time  more  con- 
spicuous, yet  underlying  them  are  always  the  massive  race 
qualities,  which,  in  proportion  to  the  number  of  generations 
through  which  they  have  passed,  tend  to  reassert  themselves 
and  reappear. 

It  is  doubtless  in  obedience  to  this  principle  that  insanity 


152  SANITY    AXI)    LVSAXITY. 

SO  often  fails  to  appear  in  the  descendants,  immediate  and 
remote,  of  the  insane.  Indeed,  were  there  not  a  natural 
tendency  for  insanity  to  die  out  and  disappear,  it  is  doubtful 
whether  there  would  be  a  single  sane  individual  left  to 
turn  the  key  on  the  rest  of  his  race  ;  for  it  is  as  difficult  to 
find  a  family  without  at  least  one  insane  member,  as  to  find 
a  litter  of  pigs  without  a  tony,  or  tithe  pig.  Hence  the 
undoubted  importance  of  inheritance  in  the  production  of 
insanity  should  never  arouse  undue  alarm  in  the  minds  of 
those  who  know  of  the  existence  of  insanity  in  their  near 
relatives  ;  for  the  influences  which  act  upon  this  factor  in 
its  production  are  so  numerous,  and  so  enormously  com- 
plex, that  it  by  no  means  follows  that  even  the  most  direct 
heredity  will  be  successful  in  producing  the  result ;  and  if 
they  knew  the  family  circumstances  of  their  sanest  and 
soberest  friends,  they  would  be  astonished  to  find  how  large 
a  proportion  of  them  come  of  a  stock  that  gives  more  or 
less  evidence  of  insanity. 

The  influence  of  reversion  is  unfortunately  not  wholly 
beneficial,  however  ;  for  although  in  many  cases  it  helps  in 
the  process  of  breeding  out  insanity,  in  some  it  is  a  direct 
factor  in  its  production.  The  children  of  the  insane,  like 
the  children  of  bleeders,  may  altogether  escape  the  malady  ; 
but  in  the  one  case  as  in  the  other,  the  grandchildren  may 
revert  to  the  qualities  of  their  grand-parents.  Where 
several  generations  have  intervened,  and  the  occurrence  of 
insanity  in  the  progenitor  has  been  forgotten,  the  appear- 
ance of  insanity  in  perhaps  but  one  member  of  a  large 
family  may  be  inexplicable  ;  but  if  inquiry  were  made,  and 
the  evidence  in  existence,  it  would  be  found  to  be  a  sporadic 
case  of  reversion. 

The  operation  of  reversion  sometimes  produces  curious 
results.  Occasionally,  under  certain  conditions,  an  individual 
of  one  sex  will  assume  many  of  the  characters  of  the  opposite 
sex,  the  reversion  being  to  its  ancestors  of  this  sex.  It  is 
well  known  that  a  large  number  of  female  birds,  when  old 
or  diseased,  or  when  operated  on,  assume  many  or  all  of 


THE    CAUSES   OF    INSANITY.  153 

the  secondary  male  characters  of  their  species.  A  duck  ten 
years  old  has  been  known  to  assume  the  perfect  winter  and 
summer  plumage  of  a  drake.  A  hen  which  had  ceased 
laying  has  assumed  the  plumage,  spurs,  voice,  and  warlike 
disposition  of  a  cock  ;  and  the  same  thing  occurs,  mutatis 
mutandis^  with  the  other  sex.  It  is  important  to  notice  that 
not  only  structural  peculiarities,  but  habits,  such  as  that  of 
incubation,  and  mental  qualities,  such  as  courage,  are  among 
the  characters  which  may  be  lost  and  gained  in  this  manner. 
The  influence  of  this  form  of  reversion,  which  also  occurs 
in  the  human  race,  upon  the  production  of  insanity,  is 
shown  in  two  wa3^s.  In  the  first  place  such  changes  are 
attended  by,  and  are  evidence  of,  an  internal  revolution  in 
the  general  organization  analogous  to  that  which  takes  place 
at  puberty,  when  the  secondary  characters  of  sex  are  first 
assumed.  The  inversion  of  sex  cannot  take  place  without  a 
commotion  analogous  to  that  of  the  assumption  of  sex  ;  and 
this  change  takes  its  place,  therefore,  among  the  stresses 
which  will  hereafter  be  considered  as  determining  causes  of 
insanity.  In  the  second  place,  this  peculiar  form  of  reversion 
is  sometimes  accompanied  by  the  production  of  long-lost 
characters  peculiar  to  some  distant  ancestral  form.  Such  a 
reversion,  if  it  take  place  in  a  man  or  woman,  and  if  it  be 
to  some  cast  of  mind  and  habits  peculiar  to  an  ancestor 
sufficiently  remote,  that  is,  to  a  form  of  life  adapted  to  vridely 
different  surroundings,  may  itself  constitute  insanity  in  the 
individual  in  whom  it  appears.  When  a  hen  assumes,  at  its 
climacteric,  the  plumage  and  characters  of  a  cock,  it  may  at 
the  same  time  revert  to  the  common  and  remote  parent  of  all 
domestic  fowls,  and  the  characters  it  assumes  may  be  that 
of  the  male  of  the  galliLS  bankiva;  and  when  a  woman  at 
her  climacteric  assumes,  as  some  women  do,  the  beard,  the 
diminished  mammae  and  the  deep  voice  and  other  characters 
of  a  man,  she  may  at  the  same  time  revert  as  to  habits  and 
mental  qualities  to  some  remote  feral  or  semi-feral  ancestor 
of  man,  and  may  in  consequence  exhibit  such  inabilitv  to 
adapt  herself  to  civilized  surroundings  as  constitutes  actual 


154  SANITY   AND   INSANITY. 

insanity.  There  is  in  every  asylum  a  certain  number  of 
bearded  and  bass-voiced  women,  whose  insanity  is  usually  of 
very  intractable  type  ;  and  I  have  had  under  care  at  the 
same  time,  two  men,  whose  hairless  faces,  large  mammae  and 
shrill  voices  betokened  an  assumption  of  the  secondary  cha- 
racters of  the  other  sex,  and  whose  insanity  was  notably  in- 
tractable. 

In  connection  with  the  subject  of  reversion  falls  to  be 
considered  the  remarkable  peculiarity  of  heredity  called 
prepotence.  Such  attributes  as  are  common  to  both  parents, 
and  are  alike  in  both,  will  tend  to  be  accurately  reproduced 
in  the  offspring  ;  but  where  the  parents  possess  contrary  or 
contradictory  attributes,  the  offspring  cannot  inherit  from 
both,  and  among  these  qualities  there  will  be,  as  it  were,  a 
struggle  for  preponderance,  for  possession  of,  or  precedence 
in  the  offspring.  The  quahty  which  obtains  the  mastery, 
and  succeeds  in  reappearing  in  the  offspring,  is  termed 
prepotent  over  the  other.  Cases  frequently  occur  in  which 
the  tendency  of  a  certain  quality  to  appear  in  the  offspring 
is  very  strong  ;  and  in  such  cases  this  tendency  is  hereditary, 
and  the  quality  is  transmitted  with  certainty  through  many 
generations.  This  tendency  to  "  breed  true  "  is  an  instance 
of  the  prepotency  of  the  quality  in  question.  Like  the  other 
manifestations  and  modifications  of  the  first  law  of  heredity, 
this  of  prepotence  appears  to  be  very  capricious  in  its  appli- 
cation. Some  qualities,  such  as  certain  colours,  are  strongly 
prepotent  in  some  animals,  and  not  at  all  in  others,  or  may 
be  prepotently  transmitted  by  one  sex  and  not  by  the  other. 
Occasionally  the  characters  first  imported  into  a  race  by  a 
single  ancestor  will  appear  in  generation  after  generation 
of  that  race  with  ineradicable  persistency.  The  prepotence 
of  the  Napoleonic  features  is  a  case  in  point.  They  have 
been  transmitted  with  surprisingly  little  variation  from 
some  common  ancestor  of  Napoleon  Buonaparte  and  his 
brothers,  to  at  least  the  fourth  generation.  The  Bourbon 
nose  appeared  so  persistently  in  the  family  as  to  be  notorious. 
The  features  of  the  Austrian  Emperors  have  been  markedly 


THE   CAUSES   OF    INSANITY.  1 55 

similar  from  generation  to  generation  ;  and  in  all  these 
cases  the  marriage,  in  each  generation,  of  the  men  with 
women  of  a  different  stock,  has  been  insufficient  to  disturb 
the  powerful  prepotent  tendency  of  the  features  of  the  father 
to  reappear  in  the  offspring. 

The  causes  of  prepotency  are  obscure,  there  being  but 
one  circumstance  which  can  be  pointed  to  as  of  unequivocal 
influence  in  enforcing  it  ;  and  this  is  the  union  of  a  parent, 
in  whom  a  quaHty  is  present  and  strongly  marked,  with  one 
in  whom  the  same  quality  is  latent  ;  in  whom,  that  is  to 
say,  there  is  an  hereditary  tendency  to  assume  that  quality, 
but  without  actual  assumption  of  it.  ''  Thus  we  have 
reason  to  believe  that  there  is  a  latent  tendency  in  all  horses 
to  be  dun-coloured  and  striped  ;  and  when  a  horse  of  this 
kind  is  crossed  with  one  of  any  other  colour,  it  is  said  that 
the  offspring  are  almost  sure  to  be  striped.  All  pigeons 
have  a  tendency  to  become  slaty  blue,  with  certain  character- 
istic marks,  and  it  is  known  that,  when  a  bird  thus  coloured 
is  crossed  with  one  of  any  other  colour,  it  is  most  difficult 
afterwards  to  eradicate  the  blue  tint." 

If  we  consider  this  question  of  prepotency  in  connection 
with  insanity,  we  shall  be  able  to  discover  two  very  valuable 
rules  for  practical  guidance.  In  the  first  place,  if  it  appears 
that  insanity  has  become  prepotent  in  a  family,  then  the 
most  stringent  measures  ought  to  be  adopted  to  prevent 
the  marriage  of  the  members  of  that  family,  and  to  avoid 
the  transmission  of  so  terrible  an  inheritance.  In  the  second 
place,  if  there  is  in  a  family  a  tendency  to  insanity,  without 
that  tendency  having  the  force  and  certainty  of  prepotence, 
then,  while  not  interdicting  the  marriage  of  its  members, 
the  greatest  precautions  should  be  taken  that  they  do  not 
marry  into  families  in  w^hich  a  similar  tendency  exists,  for  if 
they  do,  it  is  probable  that  insanity  will  appear  in  their 
offspring. 


CHAPTER  VI. 

THE    CAUSES    OF    INSANITY. 

The   Second  Laiv  of  Heredity. 

The  second  laAv  of  heredity,  which  I  have  called  the  Law  of 
Sanguinity,  is  likewise  an  important  factor  in  the  production 
of  insanity,  and  requires  the  more  notice  here,  since,  so  far 
as  I  know,  it  has  not  hitherto  received  any  attention  in  this 
regard.  The  following  is  the  best  expression  of  the  law 
that  I  have  been  able  to  construct  : — 

There  are  certain  limits^  on  the  one  hand  of  similarity^ 
and  on  the  other  of  dissimilarity^  between  two  individuals^ 
between  which  limits  only  can  the  iinion  of  those  individuals 
be  fertile  ;  and  in  proportion  as  these  limits  are  approached^ 
the  offspring  deteriorates. 

Put  in  a  somewhat  less  accurate  but  more  intelligible 
form,  the  law  will  run  thus  :  There  is  a  certain  degree  of 
dissimilarity  {sanguinity)  between  parents^  which  is  most 
favourable  for  the  production  of  iv ell-organized  offspring ; 
and  parents  who  are  more  similar  [consanguine)^  or  more 
dissimilar  {exsanguine)^  will  have  offspring  {if  any)  whose 
organization  will  be  inferior  in  proportion  to  the  distance  of 
the  parents  from  the  most  favourable  point.  In  order  to 
make  the  matter  quite  clear,  let  us  put  it  in  graphic 
form. 

Suppose  the  line  MM^  to  represent  a  series  of  males,  and 
FF^  a  series  of  females,  and  suppose  that  the  amount  of 
similarity  between  the  individuals  of  the  one  series  and 
those  of  the  other  to  be  indicated  by  the  distance  between 


THE    CAUSES    OF    INSANITY 


157 


the  lines  ;  thus,  m',  is  very  closely  similar  to  f'  ;  m=  and  f^ 
are  more  unlike,  while  m^  and  f^  are  extremely  dissimilar 
to  each  other.  Now  suppose  that  each  male  marries  the 
female  in  the  corresponding  position  of  the  other  series, 
then  the  marriages  between  SS  and  DD  will  produce  the 
best  offspring.  Marriages  between  SS  and  ss,  and  between 
DD  and  dd,  will  produce  offspring  of  inferior  organization, 
and  the  nearer  the  pairs  of  individuals  to  the  lines  ss  or  dd 
respectively,  the  more  will  the  organization  of  the  offspring 
be  impaired.  Finally  marriages  of  pairs  between  ss  and 
MF,  and  of  pairs  between  dd  and  ]\PF^  will  be  sterile  :  no 
offspring  will  be  produced. 


F~"-r- 


D 


S  D 


m 


m 


^  M' 


'S^'h 


Fig.  12. 


Let  us  take  the  case  of  similarity  or  consanguinity  first. 
Starting  from  the  point  of  similarity  which  is  the  most 
favourable  for  the  production  of  well-organized  offspring, 
we  find,  as  the  closeness  of  similarity  between  the  parents 
increases,  that  the  offspring  deteriorates  more  and  more  ; 
and  when  a  certain  degree  of  closeness  of  similarity  is 
reached,  offspring  ceases  to  be  produced.  By  similarity  is 
not  meant  here  merely  blood  relationship  as  generally 
understood.  Closeness  of  blood-relationship  is  necessary  to 
that  closeness  of  similarity  which  is  here  spoken  of,  but 
does  not  necessarily  imply  such  similarity.  While  there 
cannot  be  close  similarity  without  close  blood-relationship, 
there  may  be  close  blood-relationship  without  close  physio- 
logical similarity — similarity  of  constitution.  If  two  brothers 
inherit  very  strongly  the  character  of  one  of  their  parents, 


iSo  SANITY   AND   INSANITY. 

say  their  father,  and  if  each  of  these  brothers  transmits 
prepotently  these  paternal  qualities  to  his  children,  then 
the  cousins  thus  produced  will  have  not  only  a  close  relation- 
ship in  blood,  but  a  close  similarity  of  constitution  ;  and  if 
they  marry,  their  offspring  will  be  likely  to  be  imperfect. 
If,  however,  one  of  the  brothers  inherits  strongly  from  the 
father,  while  the  other  reverts  or  throws  back  to  the 
maternal  great-grandfather  ;  and  if  the  children  of  one  brother 
inherit  mainly  from  their  father,  while  the  qualities  of  the 


Fig.  13. 


urrrtm 


WMP 


Fig.   14. 


mother  are  prepotent  in  the  children  of  the  other,  then  it 
is  evident  that  although  the  blood-relationship  is  as  close  as 
in  the  former  pair  of  cousins,  yet  since  these  cousins  are 
virtually  derived  from  different  stocks,  they  have  a  wide 
dissimilarity  of  constitution,  and  their  offspring  are  not  likely 
to  be  imperfect.  Graphically  represented,  the  two  cases 
will  be  as  above  : — 

The  heavy  line  shows  in  each  case  the  course  of  the  main 
stream  of  qualities  ;  and  it  will  be  seen  that  while  the  one 


THE    CAUSES   OF    INSANITY.  I59> 

pair  of  cousins  derive  the  main  elements  in^their  constitu- 
tions from  the  same  source,  the  others  get  theirs  from  widely- 
different  origins,  and  hence  are  constituted  much  more 
dissimilarly. 

In  these  considerations  an  explanation  is  to  be  found  of 
the  varying  conclusions  that  have  been  reached  by  those 
who  have  studied  the  marriage  of  near  kin.  There  is  a 
popular  feeling  that  marriages  of  cousins  are  apt  to  produce 
ill  consequences  ;  and,  here  and  there,  instances  are  adduced 
in  which  ill  consequences,  in  the  shape  of  imperfect  and 
deteriorated  offspring,  have  unquestionably  followed  ;  yet 
those  who  have  made  the  most  careful  and  copious  and 
laborious  observations  of  the  marriages  of  cousins,  have  con- 
cluded that,  on  the  whole,  very  little  ill  effect  is  traceable.  If 
we  consider  how  small  is  the  number  of  cases  in  which  cousins 
inherit  very  strongly  from  one  common  grand-parent,  and 
the  still  smaller  number  in  which  the  cousins  so  inheriting 
marry,  we  shall  see  why  it  is  that  in  the  aggregate  of  cases 
of  marriage  of  cousins,  ill  effects  so  seldom  follow.  And  if 
we  remember  that  every  now  and  then  among  the  marriages 
of  cousins  there  will  occur  one  between  cousins  thus  closely 
allied,  not  only  in  blood-relationship,  but  in  physiological 
character  and  constitution,  we  shall  see  how  it  is  that 
conspicuous  instances  of  ill  effect  will  sometimes  occur,  and 
will  tend  to  bring  into  unwarranted  discredit  all  marriages 
between  cousins.  The  true  doctrine  would  seem  to  be  that 
such  marriages  are  to  be  strongly  discouraged  when  the 
cousins  are  alike,  and  when  there  is  a  taint  of  madness  or 
any  other  hereditary  disorder  in  the  common  family ;  but  that 
under  ordinary  circumstances  they  may  be  undertaken  with 
impunity. 

It  is  true  that  the  testimony  of  breeders  of  stock  is  over- 
whelmingly strong  as  to  the  evil  effects  of  inbreeding,  but 
then,  inbreeding  when  applied  to  animals  means  far  more 
than  a  simple  union  of  cousins.  It  is  admitted  on  all  hands 
that  it  is  the  effect  of  continued  inbreeding  that  is  detri- 
mental, and  the  union  of  a  pair  of  cousins  would  certainty 


l6o  SANITY   AND    INSANITY. 

not  come  under  this  description.  "Manifest  evil,"  says 
Darwin,  "  does  not  follow  from  pairing  the  nearest  relations 
for  two,  three,  and  even  four  generations."  When  the  in- 
breeding is  pushed  sufficiently  far,  the  deterioration  of  the 
offspring  is  certain,  and  the  ultimate  extinction  of  the  race 
inevitable.  About  this  there  can  be  no  doubt.  No  fact 
could  rest  on  more  secure  foundations  ;  but  this  degree  of 
inbreeding  never  happens  in  the  human  race,  and  is  only 
approached  by  the  rare  cases  of  marriage  of  cousins  who 
have  both  inherited  prepotently  from  a  common  ancestor. 
It  is  easy  to  form  genealogical  trees  of  the  Bourbons  of 
Spain,  or  the  Ptolemies,  and  to  display  an  amount  of 
inbreeding  that  appears  at  first  sight  appalling.  There  we 
find  marriages,  not  only  of  first  cousins,  of  first  cousins  the 
children  of  first  cousins,  of  uncle  with  niece,  of  brother  and 
sister,  of  brother  and  sister  the  children  of  brother  and 
sister,  but  of  relatives  of  even  closer  degrees  of  propinquity. 
Such  inbreeding,  extreme  as  it  appears  in  the  human  race, 
would  not  be  considered  very  extreme  in  the  case  of  the 
lower  animals.  If  we  take  the  genealogical  trees  and 
arrange  them  in  a  slightly  different  manner,  so  as  to  bring 
into  prominence  not  only  the  amount  of  inbreeding,  but  also 
the  points  at  which  new  blood  has  been  introduced,  it  will 
become  apparent  that  even  in  the  case  of  the  Ptolemies — the 
most  extreme  case  of  inbreeding  of  man  on  record — there  is 
no  instance  of  absence  of  a  cross  with  an  entirely  new  stock 
for  more  than  four  generations.  Compare  this  with  the 
case  of  Mr.  Wright's  pigs.  He  crossed  the  same  boar  with 
his  own  daughter,  grand-daughter,  great-grand-daughter, 
and  so  on  for  seven  generations.  The  result  Avas  that  in 
many  cases  the  offspring  failed  to  breed  ;  in  others  they 
produced  few  that  lived  ;  and  of  the  latter  many  were  idiotic, 
without  sense  even  to  suck,  and  when  attempting  to  move 
could  not  w^alk  straight.  That  the  result  was  due  to  in- 
breeding is  shown  by  the  fact  that,  when  paired  with  other 
boars,  these  sows  produced  large  litters  of  healthy  pigs.  But 
the  fact  to  observe  is  that  these  ill  effects  were  not  produced 


THE   CAUSES   OF    INSANITY.  l6l 

until  the  closest  possible  form  of  inbreeding  had  been 
continued  for  six  or  seven  generations  ;  and  there  is  reason 
to  believe  that  in  the  human  race  the  ill  effect  of  inbreeding 
would  not  appear  so  soon  as  in  the  lower  animals,  Avhose 
lives  are  shorter  and  whose  conditions  of  existence  are  far 
more  uniform. 

The  fact  of  most  importance  to  carry  forward  from  this 
discussion  is  the  character  of  the  defect  that  arises  from  in- 
breeding. The  offspring  of  an  inbred  race  are  feeble. 
When  a  mental  defect  arises,  that  defect  is  of  the  nature  of 
idiocy,  not  of  the  more  active  forms  of  insanity.  The 
testimony  of  all  breeders  of  stock  is  unanimous  that  the 
qualities  which  are  deteriorated  by  inbreeding  are  vigour 
and  robustness  ;  and  the  lack  of  vigour  and  robustness  is  the 
physical  counterpart,  as  it  is  the  physical  accompaniment,  of 
weakness  of  mind  ;  and  when  lack  of  vigour  and  robustness 
of  mind  and  body  are  pushed  to  excess,  the  case  is  one  of 
idiocy. 

Now  take  the  case  of  the  dissimilarity  or  ex-sanguinity  of 
parents.     That  a  certain  minimum  of  dissimilarity  between 
the  parents  is  necessary  for  the  production  of  any  offspring 
is  only  another  way  of  stating  what  has  just  been  said.     If 
parents  who  are  closely  inbred  fail  to  breed,  the  reason   is 
that  they  are  not  dissimilar  enough.     A  certain  minimum  of 
dissimilarity  there  must  be  between  them,   or  their    union 
will  not  be  fertile.     As  this  minimum  is  increased — as  the 
dissimilarity  between  the  parents  widens  and  increases,  their 
offspring  become  larger  and  more  vigorous  ;  better  developed 
and  better  organized  ;  exceeding,  when  a  certain  degree  of 
dissimilarity  has  been  reached,  either  of  the  parents  in  their 
organization.     With  a  still  further  increase  of  the  dissimi- 
larity of  the  parents,  the  offspring  begins  to  deteriorate  ;  but 
the  deterioration  is  of  a  totally  different  kind,  in  a  totally 
different    direction   from   that    arising    from    a    too    great 
similarity    between    the    parents.      The    offspring    remain 
vigorous,  robust,  and  well  developed,  but  they  are  wanting  in 
fertility.     They    breed   seldom    or    not    at    all.     When    the 

12 


1 62  SANITY   AND   INSANITY. 

dissimilarity  reaches  a  still  further  point,  this  sterility  rises 
from  the  second  generation  to  the  first.  No  offspring  is 
produced.     Individuals  so  dissimilar  are  sterile  inter  se. 

The  testimony  of  all  who  have  had  experience  in  this 
matter  is  quite  unanimous,  and  innumerable  cases  of  the 
most  convincing  character  have  been  recorded.  The  benefit 
of  introducing  "new  blood"  has  become  proverbial.  When- 
ever a  stock  has  become  deteriorated  by  inbreeding,  a  cross 
with  a  distinct  race  invariably  produces  a  sudden  increase 
in  their  size  and  vigour.  The  case  of  the  pigs  already 
mentioned  is  an  example.  When  the  race  was  deteriorating 
from  being  bred  in,  the  union  of  the  offspring  of  these  too- 
similar  parents  with  an  animal  of  different  race — with  a 
more  dissimilar  form — produced  offspring  both  abundant  and 
healthy.  A  race  of  fighting  cocks  which  had  been  inbred 
xmtil  they  lost  their  disposition  to  fight,  and  stood  to  be  cut 
up  without  making  any  resistance,  and  were  so  reduced  in  size 
as  to  be  disqualified  for  the  best  prizes,  regained,  on  being 
crossed  with  a  new  stock,  their  former  courage  and  weight. 
All  breeders  of  stock,  whether  of  horses,  oxen,  pigs,  dogs,  or 
other  animals,  or  of  fowls,  pigeons,  or  other  birds,  who  desire 
to  gain  size,  vigour,  and  hardihood  in  their  stock,  avoid 
inbreeding  with  the  utmost  care,  and  depend  for  the  pro- 
duction of  the  qualities  they  desire,  largely  upon  frequent 
crossing  with  distinct  strains.  On  the  other  hand,  when 
breeding  for  specific  qualities,  for  particular  markings  or 
shape  in  dogs,  for  length  of  ear  in  rabbits,  for  colour,  shape, 
and  milking  qualities  in  cattle,  for  peculiarities  of  feather, 
face,  bearing,  or  habit  in  fowls  or  pigeons,  the  tendency  is  to 
breed  closely  in  those  particular  strains  in  which  these 
qualities  are  strongly  marked  ;  and  the  consequence  is  that 
it  has  been  remarked  that  "  the  same  amateur  seldom  long 
maintains  the  superiority  of  his  birds  "  ;  for,  all  being  of  the 
same  stock,  it  becomes  essential,  in  order  to  maintain  the 
necessary  hardihood,  to  introduce  a  bird  of  another  strain, 
and  in  this  way,  while  hardihood  is  gained,  the  special 
qualities  of  beak^  or  feather,  or  what  not,  are  deteriorated. 


THE   CAUSES   OF   INSANITY.  1 63 

Sir  John  Sebright  declares  that  by  breeding  in  and  in  he 
has  actually  seen  the  offspring  of  strong  spaniels  degenerate 
into  weak  and  diminutive  lap-dogs.  The  most  incontro- 
vertible evidence,  however,  is  that  of  money  value,  and  it  is  a 
well-established  principle  among  all  breeders  of  stock,  that 
for  the  purposes  of  the  butcher  and  the  cook,  that  is  to  say 
for  size,  weight,  and  early  maturity,  the  value  of  cross-bred 
animals  is  indisputably  greater  than  that  of  pure  stock.  The 
beneficial  effect  of  crossing  varieties  of  fruit-yielding  plants 
has  been  described  by  experienced  gardeners  as  "  astonish- 
ing-" 

In  all  the  foregoing  cases   the  dissimilarity  between  the 

parents  is  not  very  great,  and  in  all  cases  in  which  the 
dissimilarity  reaches,  without  exceeding,  a  certain  indefinable 
limit,  the  offspring  benefits,  and  becomes  a  better  organism 
than  either  of  its  parents.  When,  however,  the  dissimilarity 
between  the  parents  is  still  further  increased,  the  offspring 
begins  to  deteriorate.  Instead  of  deteriorating  in  size  and 
vigour,  as  occurs  when  the  parents  become  more  alike,  the 
offspring  exhibits  a  falling  off  in  fertility.  As  its  parents 
increase  and  widen  in  their  unlikeness  to  each  other,  its  off- 
spring— the  grand-children  of  these  parents — become  fewer 
and  fewer,  and  at  length  cease  to  be  produced.  The  sterility 
of  mules  and  of  hybrids  generally  is  a  sufficiently  well- 
proved  and  notorious  fact.  It  has  been  proved  that  among 
certain  plants,  a  series  can  be  formed,  of  species  of  gradually 
increasing  dissimilarity,  from  pairs  which,  when  crossed, 
yield  fewer  and  fewer  seeds,  to  species  which  never  produce 
a  single  seed,  but  yet  are  affected  by  the  pollen  of  other 
species,  for  the  germen  swells  ;  and  so  on  to  pairs  so  divergent 
that  not  even  this  effect  is  produced. 

With  the  diminution  of  fertility  resulting  from  the  union 
•of  too-dissimilar  forms,  we  are  not,  in  seeking  the  causation 
of  insanity,  concerned  ;  but  the  other  effect — the  increase  of 
size,  vigour  and  hardihood — resulting  from  the  union  of 
sufficiently  dissimilar  parents,  concerns  us  nearly.  Before 
•considering  the  bearing  of  these  facts  on  the  production  of 


164  SANITY    AND    INSANITY. 

insanity,  it  will,  however,  be  necessary  to  mention  two 
incidental  effects  which  result  from  the  union  of  rather 
widely  dissimilar  forms. 

The  first  of  these  is  the  production  of  reversion,  which  is 
a  frequent  result  of  cross-breeding.  Darwin  gives  many 
wonderful  instances  of  this  occurrence,  which  he  was  himself 
the  first  to  establish.  He  selected  long-established  pure 
breeds  of  fowls  in  which  there  was  not  a  trace  of  red,  yet  in 
several  of  the  mongrels  this  colour  appeared,  and  one 
magnificent  bird,  the  offspring  of  a  black  Spanish  cock  and 
a  white  silk  hen,  was  coloured  almost  exactly  like  the  wild 
ealhcs  hankiva^  the  remote  ancestor  of  both.  "  All  who 
know  anything  of  the  breeding  of  poultry  will  admit  that 
tens  of  thousands  of  pure  Spanish  and  pure  white  silk  fowls 
might  have  been  reared  without  the  appearance  of  a  red 
feather,"  and  would  agree  that  hundreds,  and  perhaps 
thousands  of  generations  must  have  intervened  between 
the  wild  bird  and  the  remote  descendant  which  so  resembled 
it.  Again,  some  breeds  of  fowls  have  lost  the  instinct  of 
incubation,  yet  when  two  such  breeds  are  crossed,  the 
instinct  reappears,  and  the  mongrel  sits  with  remarkable 
steadiness.  Professor  Jaeger  crossed  the  Japanese,  or 
masked  pig,  with  the  common  German  breed,  and  the  off- 
spring were  intermediate  in  character.  He  then  re-crossed 
these  mongrels  with  the  pure  Japanese,  and  in  the  litter 
thus  produced  one  of  the  young  resembled  in  all  its 
characters  a  wild  pig. 

The  second  of  the  incidental  effects  of  crossing  is  this  : 
when  a  domesticated  animal  is  crossed  with  a  distinct 
species,  whether  this  is  a  domesticated  or  only  a  tamed 
animal,  the  hybrids  are  often  wild  to  a  remarkable  degree. 
This  has  been  noticed  in  the  cases  of  pigs,  goats,  ducks, 
cattle,  fowls,  and  other  animals.  Mules,  it  is  true,  are  not  at 
all  wild,  but  they  arc  notorious  for  obstinacy  and  vice. 
These  facts,  Darwin  goes  on  to  say,  "  remind  us  of  the 
statements  so  frequently  made  by  travellers  in  all  parts  of 
the  world  on  the   degraded  state  and  savage  disposition  of 


( 


THE   CAUSES   OF    INSANITY.  1 6$ 

crossed  races  of  man."  Livingstone  remarks  that  half-castes 
are  much  more  cruel  than  Portuguese.  An  inhabitant 
remarked  to  Livingstone,  "  God  made  the  white  men,  and 
God  made  the  black  men,  but  the  devil  made  the  half- 
castes." 

There  is  yet  one  other  phenomenon  in  procreation  which 
requires  notice  before  we  can  draw  from  all  the  facts  the 
inferences  that  will  show  us  the  bearing  of  the  second  law 
of  inheritance  on  the  production  cf  insanity.  This  is  the 
phenomenon  of  parthenogenesis.  It  is  commonly  supposed 
that  the  ovum  does  not  begin  to  Hve  until  the  male  element 
acts  upon  it,  and  imparts  life  to  it  ;  but  this  is  an  error. 
In  all  organisms  the  ovum  undergoes  a  certain  amount 
of  development  before  the  male  element  reaches  it.  The 
ovum  of  mammalia,  while  still  in  the  ovary,  enlarges  and 
dev elopes.  The  nucleus  divides,  and  portions  of  it  are 
expelled  as  the  "  polar  globules."  When  the  o\'um  escapes 
from  the  ovary,  a  further  change  in  the  direction  of  develop- 
ment takes  place  ;  but  if  impregnation  does  not  now  occur, 
the  changes  proceed  no  further,  development  ceases  and  th-e 
ovum  perishes.  If,  however,  the  ovum  comes  in  contact 
with  the  male  element,  a  fresh  start  is  made,  an  enormous 
impetus  is  given  to  the  process  already  begun,  and  under 
the  propulsion  of  the  impetus  so  given,  the  ovum  passes 
through  the  prodigious  series  of  changes  involved  in  the 
process  of  unfolding  from  a  simple  cell  to  the  marvellously 
complex  and  elaborate  structure  of  the  adult  organism. 
The  factor  imported  into  the  process  by  the  male  element 
is  of  the  nature  of  an  impetus^  and  on  the  magnitude  of  this 
impetus  depends  the  length  of  time  during  which  develop- 
ment shall  be  continued,  and  the  extent  to  which  it  shall 
proceed. 

The  next  step  in  the  development  of  the  ovum  after  the 
impregnation,  is  the  "  segmentation  of  the  yolk,"  or  the 
spontaneous  division  of  the  cell  substance  first  into  two,  then 
into  four,  then  into  eight,  and  so  on  into  very  many  small  por- 
tions.   This  segmentation  does  not  usually  take  place  in  the 


1 66  SANITY   AND   INSANITY. 

mammalian  ovum  unless  and  until  the  ovum  is  impregnated 
by  the  male  element  ;  but  in  many  of  the  lower  animals^ 
and  in  some  mammals,  the  development  of  the  unim- 
pregnated  ovum  does  proceed  thus  far,  and  segmentation 
takes  place  even  without  impregnation.  There  are  again 
other  cases,  among  the  lower  animals,  in  which  the  develop- 
ment of  the  unimpregnated  ovum  goes  beyond  the  mere 
segmentation  of  the  yolk,  and  proceeds  as  far  as  the  formation 
of  an  imperfect  embryo.  Yet  again  it  happens  occasionally 
in  some  insects,  e.g.^  some  moths,  that  not  only  are  eggs  laid 
without  concourse  with  the  male,  but  a  small  proportion  of 
these  eggs  actually  hatch,  and  develop  into  living  caterpillars. 
Some  of  these  caterpillars  develop  into  moths,  in  every 
respect  resembling  their  single  parent.  This  phenomenon 
of  parthenogenesis,  or  asexual  or  unisexual  generation,  which 
happens  occasionally  and  exceptionally  in  the  higher  insects^ 
becomes  in  some  of  the  lower  insects  almost  the  rule.  That 
is  to  say,  there  are  certain  low  forms  of  insect  life — 
aphides — in  which  offspring,  living  and  vigorous  offspring^ 
are  habitually  produced  without  concourse  with  the  male. 
Hence  it  appears  that,  apart  from  the  impetus  communicated 
by  the  male  element,  the  female  element  alone  possesses  a 
certain  momentum  in  the  same  direction,  a  momentum 
which  is  always  present  in  some  degree,  and  will  always 
carry  the  process  of  development  to  a  greater  or  less  distance^ 
and  which  is  sometimes  even  sufficient  to  carry  it  far  enough 
to  produce  a  perfect  offspring. 

Although,  however,  the  female  possesses  this  intrinsic 
momentum,  yet  in  the  vast  majority  of  cases  the  momentum 
is  insufficient  of  itself  to  carry  the  development  far  enough 
to  produce  perfect  offspring  ;  and  even  in  the  extreme  cases 
in  which  this  effect  is  produced,  the  female  influence  alone 
is  not  sufficient  to  carry  on  the  process  indefinitely.  The 
caterpillars  which  are  derived  from  a  virgin  mother,  cannot^ 
on  reaching  their  adult  stature  as  moths,  lay  fertile  eggs 
without  the  assistance  of  the  male.  Aphides  can  produce 
one,  or  two,  or  several,  generations   of  virgin   mothers,  but 


THE   CAUSES   OF    INSANITY.  1 67 

unless  the  aid  of  the  male  is  at  length  evoked  to  give  a  new 
impetus  to  the  process  of  development,  the  momentum, 
existing  in  the  female  line  only,  dies  away,  and  no  offspring 
is  produced. 

It  is  next  to  be  noticed  that  the  vigour  of  the  impetus 
given  to  the  process  of  development  by  the  union  of  the 
male  element  with  the  ovum,  varies  in  different  cases.  In  the 
first  place,  the  larger  the  number  of  male  elements  that  act 
on  the  ovum,  the  more  vigorous  is  the  impulse  given  to  the 
process  of  development.  Naudin  fertilized  a  flower  with 
three  grains  of  pollen,  and  succeeded  perfectly.  He  then 
fertilized  twelve  flowers  with  two  grains  each,  and  reared 
but  a  single  seed.  With  one  grain  each  he  had  to  fertilize 
seventeen  flowers  before  a  seed  was  produced.  These  two 
latter  seeds  produced  plants  which  never  attained  their 
proper  dimensions,  and  bore  flowers  of  remarkably  small 
size.^ 

In  the  second  place  the  more  vigorous  the  male  element, 
the  greater  is  the  impulse  given  to  the  process  of  develop- 
ment. It  is  a  commonplace  among  all  breeders  of  stock  of 
whatever  kind,  that  for  the  production  of  the  finest  offspring, 
the  healthiest  and  most  vigorous  males  must  be  used  as 
stock  getters.  The  rule  amongst  breeders  of  such  prize 
poultry  as  need  size  as  a  condition  of  success,  is  to  discard 
the  male  birds  after  their  first  year  of  service. 

In  the  third  place,  the  more  different  the  male  element  is 
from  the  female,  the  greater  the  impulse  given  to  the 
process  of  development,  providing  that  the  elements  are 
sufficiently  similar  for  union  to  take  place  at  all.  The 
momentum  in  the  direction  of  development  which  the  ovum 
possesses,  does  not,  it  is  evident,  depend  on  the  size  of  the 
ovum,  for  the  minute  ova  of  aphides  possess  a  momentum 
which  carries  them  further  than  the  much  larger  ova  of 
birds.  Hence,  supposing  we  were  able  to  increase  the  size 
of  the  ova  by  the  addition  of  more  matter  from  the  maternal 

'  It  is  now  believed  that  in  animals  a  single  spermatozoon  only  unites  with 
the  ovum. 


1 68  SANITY   AND   INSANITY. 

organism,  there  is  no  reason  to  suppose  that  we  should 
thereby  be  storing  in  the  ovum  an  addition  to  the  develop- 
mental energy^  or  enabling  the  ovum  to  proceed  farther  in 
the  path  of  development  without  help  from  the  impulse  of 
the  male.  If,  instead  of  an  increase  in  the  original  size  of 
the  ovum,  the  latter  were  to  be  increased  by  the  addition  to 
it,  after  it  had  been  formed,  of  new  matter  of  similar 
constitution  from  the  mother  form,  there  is  no  reason  to 
think  that  the  developmental  impulse  would  be  increased 
thereby.  Supposing  that  the  new  matter  were  added  in  the 
form  of  particles  similar  to  the  male  elements,  but  derived 
from  the  mother,  formed  in  the  ovary  alongside  of  the 
ovum,  still  they  would  give  to  the  ovum  no  accession  of 
energy  in  the  direction  of  development.  In  order  to  produce 
such  an  accession  of  energy  there  must  be  some  difference 
between  the  matter  composing  the  ovum,  and  the  matter 
that  is  added  to  and  unites  with  it  ;  hence  the  universal 
necessity  for  sexual  intercourse.  When  the  male  element, 
without  being  indentical  with  the  female,  is  yet  very  closely 
similar,  derived  not  indeed  from  the  mother,  but  from  an 
organism  of  very  closely  similar  constitution,  the  impulse 
given  to  the  process  of  development,  although  considerable, 
is  yet  not  sufficient  to  carry  that  process  so  far  as  to  produce 
completely  developed  offspring.  Hence  in  cases  of  inbreed- 
ing the  offspring  are  defective,  and  they  are  defective  in 
just  such  ways  as  indicate  that  the  process  of  development 
has  come  to  an  end  prematurely.  For  what  will  happen 
when  the  developmental  process  is  wanting  in  vigour  ? 
The  greater  the  initial  impetus  given  to  a  rolling  ball  or  a 
flying  arrow,  the  further  the  ball  will  roll,  or  the  arrow  will 
fly,  before  the  retarding  influence  of  friction  brings  the 
movement  to  a  stay.  And  the  greater  the  initial  impetus 
given  to  the  germ  of  an  organism,  the  further  the  organism 
will  proceed  in  development  before  the  impetus  is  spent  and 
the  retarding  influence  of  opposing  forces  brings  the  process 
to  a  standstill.  Of  the  results  and  signs  of  the  progress  of 
development  the  most  conspicuous  is  increase  of  size.     From 


THE   CAUSES   OF    INSANITY.  1 69 

the  microscopic  germ,  having  a  diameter  of  one  two- 
hundreth  of  an  inch  or  less,  to  the  adult  individual  of 
between  five  and  six  feet  in  stature,  the  progress  is  con- 
tinuous ;  and  the  stronger  the  original  impetus  given  to  the 
developmental  process,  the  further  this  process  will  be 
carried  in  this  particular,  and  the  greater  will  be  the  size 
attained  by  the  adult  animal.  Hence  we  find  that  in  breed- 
ing for  size,  the  invariable  practice  is  to  avoid  inbreeding 
and  to  maintain  a  succession  of  crosses  with  new  blood  ; 
and  conversely,  we  find  that  the  result  of  inbreeding,  which 
diminishes  the  vigour  of  the  initial  impetus,  is  to  deteriorate 
the  offspring  in  size. 

If  two  balls  are  set  rolling  along  the  ground  one  after  the 
other  in  the  same  track,  but  the  second  with  an  impetus  less 
than  the  first,  the  result  will  be,  of  course,  that  the  first  ball 
will  travel  farthest.  The  difference  between  the  progress  of 
the  two  balls  will  scarcely  be  perceptible  in  the  early  part  of 
their  course,  the  velocities  at  starting,  though  different, 
will  not  be  conspicuously  different,  and  the  directions  will 
be  the  same.  When  two-thirds  or  three-fourths  of  the 
course  is  run,  however,  and  the  balls  have  slackened  in 
speed,  and  their  momentum  is  diminished,  it  will  happen 
that  trifling  irregularities  in  the  ground,  which  were  not 
sufficient  to  influence  the  course  of  the  bowls  in  the  early 
part  of  their  career,  when  velocity  was  high  and  momentum 
great,  will  produce  sensible  deviations  in  the  line  of  direction. 
Since  the  momentum  of  the  second  ball  is  less  than  that  of 
the  first,  these  deviations  will  set  in  at  an  earlier  period  in 
the  course  of  the  second  ball,  and  the  general  results  of  its 
diminished  impetus  will  be,  first,  that  it  will  not  travel  so  far, 
that  the  last  part  of  its  career  will  be  deficient,  and  second, 
that  the  deviation  of  its  course  from  a  straight  line  w411  set 
in  sooner  ;  it  will  be  more  easily  diverted  from  its  course. 

Similarly  in  the  case  of  a  developing  organism.  That 
organism,  which  receives  the  weaker  impetus,  will  differ 
from  this  which  receives  the  stronger  impetus,  in  several 
ways.      It    will    not    pass  through   the  early  stages    of  its 


lyo  SANITY   AND   INSANITY. 

development  quite  so  fast  as  the  more  vigorous  germ,  but 
the  difference  in  the  rapidity  of  development  will  not  be 
conspicuous  until  a  comparatively  advanced  stage  is  reached  ; 
and  then  it  will  be  seen  that  the  one  organism  is  continuing 
strongly  and  vigorously  to  develop,  while  the  development 
of  the  other  is  coming  to  a  standstill.  Just  as  it  is  the  last 
part  of  the  career  of  the  slower  ball  which  is  deficient,  so  it 
is  the  last  stages  in  the  development  of  the  less  vigorous 
germ  which  fail  to  be  traversed.  What  are  the  last  stages  of 
development  ?  If  we  watch  the  germ  through  the  process  of 
its  evolution  into  the  adult  organism,  we  find  that  first  there 
is  an  indication  of  difference  between  the  head  and  the  body^ 
then  appears  the  spine — the  foundation  of  the  skeleton — 
then  the  heart,  the  intestinal  canal,  the  lungs,  the  limbs,  and 
so  on.  The  several  organs  and  systems  grow,  develop,  and 
eventually  become  complete,  reaching  their  final  stage  at 
very  different  periods  of  life,  some  attaining  completion  long 
before  birth,  others  being  incomplete  until  adult  age  is 
reached.  So  in  the  plant  raised  from  seed — the  first  things  to 
develop  are  the  radicle  and  plumule,  then  the  leaves,  then 
the  stem,  and  last  of  all  the  flower  and  fruit ;  which  latter 
mark  the  attainment  of  adult  age  by  the  plant.  Now  the 
flower  of  the  human  organism  is  the  highest  portion  of  the 
nervous  system.  This  is  the  region  in  which  development 
attains  its  supremest  height.  All  the  rest  of  the  body  is  but^ 
as  it  were,  the  foundation  of,  and  preparation  for,  the  highest 
nervous  regions.  The  body  is  but  a  house  for  them  to  live 
in,  an  apparatus  for  them  to  act  through,  an  organization 
for  them  to  control.  They  are  the  culmination  and  climax 
of  the  process  of  development.  Hence,  if  development  is  not 
carried  far  enough,  if  it  fails  to  reach  its  latest  stages,  if  its 
forces  are  spent  ere  its  full  course  is  run,  the  part  whose 
development  will  fail  to  be  attained  will  be  the  highest 
nervous  regions.  And  what  is  the  evidence  ?  The  evidence 
is  that  in  close  inbreeding  not  only  do  the  late  offspring  of 
such  inbreeding  fail  to  reach  the  full  size  and  stature  of  their 
race,  but    the  highest   nervous    regions   fail    to  attain    the 


THE   CAUSES   OF    INSANITY.  I7I 

development  normal  to  that  class  of  organism.  They  are 
idiotic.  The  inbred  fighting  cocks  stand  to  be  cut  up 
without  making  any  resistance.  The  inbred  pigs  have  not 
sense  even  to  suck. 

Here  we  have  to  notice  that  not  all  idiots,  indeed  but  few 
idiots,  owe  their  deficient  development  to  inbreeding  ;  but 
nevertheless  all  cases  of  idiocy,  and  of  congenital  imbecility,, 
which  is  a  lesser  degree  of  idiocy,  owe  their  defect  to  the 
weakness  of  the  original  impetus  with  which  the  germ  started 
on  its  career  of  development.  There  are,  then,  other  sources- 
of  weakness  of  impetus  besides  the  too  great  similarity 
between  the  germ  cell  and  the  sperm  cell.  What  these 
sources  are  we  have  already  seen  in  part.  The  insufficient 
impetus  given  by  the  male  element  may  be  due  to  its  own 
inherent  weakness — -a  weakness  which  may  in  some  cases  be 
due  to  and  measured  by  the  constitutional  weakness  or  ill 
health  of  the  male  parent.  In  other  cases  a  man  who  is 
healthy  and  constitutionally  strong  in  other  respects,  may 
yet  be  unable  to  procreate  healthy  and  vigorous  children  ; 
and  if  his  children  are  stunted  and  feeble,  it  will  be  likely 
that  they  will  also  be  deficient  in  intellect.  In  other  cases 
again,  the  failure  in  vigour  that  occurs  with  advancing  life^ 
and  which  weighs  on  the  procreative  function  with  at  least 
as  heavy  a  stress  as  upon  the  other  functions,  may  be  the 
cause  of  the  lack  of  vigour  in  the  impetus  that  is  given  to  the 
germ.  Hence  children,  who  are  born  late  in  the  life  of  the 
parents,  are  seldom  as  intellectual  as  those  born  at  the  period 
of  greatest  vigour ;  and  when  all  the  children  are  defective,, 
those  who  are  born  latest  are  most  defective.  Dr.  Clouston 
records  a  most  instructive  case  of  a  lady,  herself  upon  the 
borderland  of  insanity,  who  had  fourteen  children.  "  The 
first  four  of  these  were  fairly  healthy,  and  are  still  living  ; 
then  came  the  subject  of  the  present  note  (a  certified 
lunatic)  .  .  .  and  after  her  came  nine  children,  all  of  whom 
are  now  dead.  The  elder  ones  lived  longest  ;  and  then,  as 
the  mother  grew  in  years,  the  strain  on  her  became  greater^ 
the  duration  of  the  life  of  her  offspring  shortened." 


172  SANITY   AND   INSANITY. 

Or  the  insufficient  impetus  may,  as  we  have  seen,  be  due 
to  an  insufficiency  in  the  member  of  male  elements  which 
reach  and  unite  with  the  ovum.  Here  again  the  fault  may 
be  in  the  male,  who  produces  elements  in  insufficient 
quantity,  or  it  may  be  that  a  sufficient  quantity  is  pro- 
duced, but  from  some  accidental  cause,  enough  do  not  reach 
the  ovum  to  give  the  requisite  impulse  to  the  develop- 
mental process,  and  this  may  account  for  the  occasional 
occurrence  of  a  single  case  of  idiocy  in  a  family  of  other- 
wise vigorous  and  healthy  children. 

Again,  the  insufficient  impetus  may  be  due  to  some  un- 
suitability  of  the  male  to  the  female  element.  What  the  cause 
or  nature  of  the  unsuitabilitymaybewe  do  not  know,  but  it  is  a 
well-ascertained  fact  that  females,  which  were  either  previously 
or  subsequently  proved  to  be  fertile,  have  failed  to  breed 
with  particular  males,  also  of  undoubted  fertility.  Instances 
have  been  observed  with  horses,  cattle,  pigs,  foxhounds  and 
other  dogs,  and  pigeons.  Now  if  we  suppose  the  un- 
suitability  or  incompatibility  of  the  male  to  the  female  to 
be  somewhat  less  in  degree,  so  that  some  offspring  would  be 
produced  ;  but  to  still  exist,  so  that  the  impetus  given  to  the 
germ  would  be  insufficient  to  produce  perfect  offspring,  we 
should  have  another  cause  for  the  production  of  idiocy. 

The  defect  in  the  vigour  of  the  developmental  impetus 
need  not  necessarily  be  in  the  male  element,  nor  in  the 
unsuitability  of  the  male  element,  from  too  great  similarity 
or  difference  or  other  cause,  to  the  female  ;  it  may  lie  in  the 
defective  vigour  of  the  germ  itself.  We  have  seen  how 
every  germ  has  of  itself  a  certain  tendency  to  develop,  and 
how  in  some  cases  this  tendency  is  carried  to  actual  com- 
pletion, and  to  the  production  of  offspring  without  help 
from  the  male.  Ordinarily  the  additional  impetus  imparted 
by  the  union  of  the  male  element  is  required  to  carry  the 
process  to  completion,  and  ordinarily  this  impetus  is 
sufficient.  But  it  may  happen  that  the  germ  itself  is  of  so 
sluggish  a  nature,  and  contains  within  itself  so  feeble  a 
capacity  for  development,  that  not  evtn  the  impetus  given 


THE    CAUSES    OF    INSANITY.  173 

by  the  union  of  abundance  of  suitable  and  vigorous  male 
elements  is  sufficient  to  give  it  the  necessary  start,  and  the 
process  comes  to  a  premature  close,  with  the  result  that  the 
offspring  is  idiotic. 

Any  condition  of  impaired  vigour  in  the  female,  present 
at  the  time  of  conception,  may  be  a  cause  of  this  defect  of 
energy  in  the  germ.  Thus  we  find  that  the  children  born 
at  the  extreme  end  of  the  child-bearing  period  are  seldom 
of  great  bodily  or  mental  vigour,  and  that  when  a  woman 
has  suffered  during  her  pregnancy  from  an  exhausting 
disease,  the  child  may  be  idiotic. 

If  idiocy  and  imbecility  be,  as  is  here  asserted,  due  to  a 
premature  cessation  of  the  process  of  development,  then  we 
should  expect  to  find  in  idiots  and  in  imbeciles  other 
evidence,  if  other  evidence  there  be,  of  this  premature 
cessation.  It  has  already  been  shown  that  one  other  effect 
of  the  early  failure  of  the  process  of  development  will  be 
the  inaptitude  of  the  individual  in  whom  it  so  fails  to  attain 
the  full  size  and  stature  of  his  race  ;  and  it  is  an  indisput- 
able fact  that  the  vast  majority  of  idiots  and  imbeciles  are 
stunted  and  undersized. 

Although  this  is  the  rule,  it  is  not  an  absolute  rule  ; 
imbeciles  being  occasionally  of  normal  stature  and  propor- 
tions ;  and  it  is  notorious  that  giants  are  almost  always 
persons  of  feeble  intellect,  while  many  men  of  undoubted 
genius  have  been  of  diminutive  stature  ;  so  that  some  factor 
in  the  causation  of  feebleness  of  mind,  which  accounts  for 
such  cases,  must  have  been  hitherto  overlooked.  The  factor 
in  question  seems  to  be  this  :  Between  mere  growth,  that  is  to 
say,  increase  of  size,  and  development,  or  increase  in  elabo- 
rateness and  complexity,  there  is  a  certain  antagonism,  so  that 
growth  in  size  proceeds  partly  at  the  expense  of  increase  in 
elaborateness,  and  vice  versa.  It  requires  a  genetic  impulse 
of  very  unusual  vigour  to  produce  an  organism  of  more 
than  average  size,  which  also  carries  the  last  and  most 
elaborate  stages  of  organization  to  a  more  than  average 
extent.     Plants  which  grow  very  luxuriantly,  and  attain  an 


3  74  SANITY   AND   INSANITY. 

unusual  size,  sometimes  do  not  flower.  European  vege- 
tables in  the  hot  climate  of  India  grow  to  rampant  excess  ; 
and  in  order  to  make  them  yield  seed  it  has  been  found 
necessary  to  reduce  this  excess  of  growth,  by  cutting  and 
mutilating  the  roots  or  stems.  Fruit-trees  which  are 
^'  making  too  much  wood  "  are  always  regarded  unfavour- 
ably by  gardeners,  for  they  never  bear  much  fruit.  The 
highest  nerve  regions  have  already  been  shown  to  be  the 
highest  and  last  outcome  of  human  development,  the 
supreme  climax  of  the  unfolding  of  the  organism,  and  to 
he  in  this  respect  comparable  to  the  flower  and  fruit  of 
plants.  From  this  point  of  view,  the  feeble  intellect,  often 
found  in  persons  of  abnormal  size,  becomes  explicable  ;  and 
the  small  stature  of  many  of  the  men  of  great  genius,  whose 
names  live  in  history,  likewise  receives  an  explanation.  We 
have  to  suppose  that  up  to  a  certain  point  growth  and 
development  proceed  pari passii^  but  that  at  length  the  one 
gains  a  preponderance  over  the  other  and  increases  at  its 
expense.  If  we  train  a  fruit-tree  into  what  gardeners  call  a 
■"  double  oblique  cordon,"  that  is  to  say,  into  such  a  form 
that  it  has  two  main  branches  of  equal  size,  and  growing  in 
a  slanting  direction  at  equal  angles  with  the  horizontal, 
there  is  no  difficulty  in  maintaining  the  equality  between 
the  size  of  the  branches,  as  long  as  the  angles  at  which  they 
grow  are  equal.  But  if  we  allow  one  branch  to  grow  more 
erect  than  the  other,  it  at  once  begins  to  preponderate  in 
size.  It  is  not  merely  that  the  more  upright  branch  grows 
more  quickly,  but  that  it  diverts  to  its  own  use  sap  that 
should  have  flowed  to  the  other  branch,  and  thus  retards 
the  growth  of  that  other.  Both  depend  for  their  nourish- 
ment on  a  common  supply  ;  and  the  more  of  this  supply  is 
appropriated  by  the  one,  the  less  remains  at  the  service  of 
the  other.  Similarly  there  are  two  branches  to  the  evolu- 
tion of  the  human  organism  : — growth,  and  elaboration,  both 
drawing  from  a  common  source  the  energy  which  keeps 
them  going.  If  either  process  appropriates  to  its  own  use 
more   than   a  just   moiety   of  energy,   it  will   increase,  not 


THE    CAUSES   OF    INSANITY.  I75 

merely  faster  than  the  other,  but  at  the  expense  of  the 
•other  ;  and  by  as  much  as  the  one  exceeds  the  standard 
which  it  would  have  attained  had  the  forces  been  equally 
apportioned,  by  so  much  the  other  falls  short  of  that 
standard. 

Original  or  congenital  deficiency  of  intellect,  which,  when 
extreme,  is  called  idiocy,  when  less  in  degree  but  still  very 
■decided,  is  called  imbecility,  and  when  of  still  less  degree  is 
termed  weakness  of  mind,  is  always  due  to  a  premature 
■cessation  of  the  process  of  development,  from  which  results 
an  absence  of  the  last  results  of  the  developmental  process — 
the  highest  of  all  the  nerve  regions.  This  premature 
cessation  of  development  depends,  in  the  great  majority  of 
cases,  on  a  defect  in  the  original  impulse  with  VN^hich  the 
process  started,  the  effect  of  which  is  that  the  process  dies 
out  before  it  is  completed.  In  a  few  cases,  however,  it 
liappens  that  the  original  impulse  was  sufficient,  but  that 
an  undue  share  of  the  energy  so  derived  has  gone  to 
produce  mere  increase  of  size,  leaving  too  small  a  remainder 
to  carry  the  process  of  development  to  completion.  Such 
are  the  conclusions  to  which  we  are  brought  by  a  study  of 
the  results  of  inbreeding.  Let  us  now  turn  to  the  converse 
aspect  of  the  case  and  trace  the  results  of  the  union  of 
widely  dissimilar  parents. 

It  has  been  shown  that  the  vigour  of  the  impetus,  w^hich 
the  ovum  receives  from  the  union  of  the  male  element, 
■depends  in  part  upon  the  degree  to  which  the  male  element 
■differs  from  the  female  ;  and  it  has  been  further  shown  that 
there  are  other  factors  which  make  for  or  against  an 
•energetic  start  of  the  developmental  process.  These  other 
factors  are,  as  we  have  already  seen,  inherent  vigour  of  the 
female,  and  of  the  male  elements,  number  of  the  latter,  and 
suitability  of  the  latter  to  the  former,  both  in  degree  of 
difference  and  in  other  unknown  particulars.  Granted  that 
the  circumstances  are  favourable,  and  that  the  germ  receives 
a  vigorous  impulse  to  start  it  on  its  course  of  development, 
"we  have  next  to  notice  that  the  vigour  of  the  impulse  may 


Ij6  SANITY    AND    INSANITY. 

exhibit  itself  in  different  ways.     To  recur  to  our  simile  of 
the  rolling  ball.     Let  us  suppose  that  two  bowls  of  equal 
size  are  started  rolling  along  a  lawn  ;  and  let  us  suppose  that 
one  ball  is  of  solid  ligmim  vitce^  and  the  other  is  of  hollow 
india-rubber.     The  result  will  be  that,  if  the  velocities  are 
duly  proportioned  and  the  lawn  is  smooth,  both  balls  will 
travel  about  the  same  distance  and  in  a  direct  line  ;  but  if 
the  lawn  is  lumpy  with  worm-casts  and  tufts  of  grass,  the 
heavy  ball  will  crush  the  obstacles  and  hold  its  own  course 
in  spite  of  them,  while  the  light  one  will,  especially  towards 
the  end  of  its  course  when  its  velocity  is  diminishing,  be 
diverted  from  the  straight  direction  by   each   irregularity 
that  it  strikes  against,  and  will  come  to  rest  at  a  greater  or 
less  distance  from  the  direct  line  of  propulsion.     There  is  a 
similar  set  of  conditions  influencing  the  progress  of  organ- 
isms   along    the    path    of    development  ;    for    while    some 
progress    steadily    in    the    straightforward  direction   of  the 
general  course  of  development  common  to  the  race,  others, 
although  developing  to  an  equal  extent,  going  equally  far 
in  the  elaborateness  and  completeness  of  their  development, 
attaining  an  equal   degree   of   ability,  yet   diverge   in  new 
directions,  exhibit   their  ability  in  different   ways,  or  even 
swerve  so  far  out  of  the  usual  line  as  to  exhibit  eccentricities 
of  conduct  which  amount  to  actual  insanity. 

What  the  precise  conditions  are  which  make  this  differ- 
ence in  the  course  of  development  it  is  not  yet  possible  to 
say,  but  undoubtedly  one  most  important  factor  is  the  rate 
at  which  the  development  takes  place.  The  extent  to  which 
development  proceeds — the  height  that  it  attains — depends 
upon  the  vigour  of  the  initial  impetus  that  is  given  to  the 
process  ;  and  consequently  two  individuals  receiving  im- 
petus of  equal  magnitude  will  proceed  equally  far  and  attain 
an  equal  elaborateness  of  development.  But  although  they 
attain  equal  heights  of  development,  they  may  not  attain 
these  equal  heights  in  equal  times.  One  may  develop 
rapidly,  and  attain  completion  while  the  other  is  still 
immature,  while  the   other   may  tardily,  and  after  a  long 


THE    CAUSES   OF    INSANITY.  1 77 

interval,  reach  the  same  degree  of  perfection  ;  and  the 
results  of  the  two  processes,  which  are  of  equal  extent,  will 
differ  greatly  according  to  the  velocity  with  which  they  have 
been  conducted. 

When  a  carpenter  is  making  some  common  rough  article 
to  serve  a  temporary  purpose,  such  as  a   packing-case  or  a 
crate,  or  when  he  is  making  a  structure  which  is  not  intended 
to  bear  stress  of  weather  or  to  be  exposed  to  the  destructive 
agency  of  Avet  and  frost,  such  as  rafters  or  flooring,  he  uses 
some  soft  wood,  such  as  deal  or  pine,  the  product  of  a  quickly- 
growing  tree.     But  when  he  is  making  some  object  which 
is  meant  to  last,  such  as  cabinet  work  or  ornamental  carv- 
ing, or  when  he  is  making  an  article  like  a  gate-post  or  a 
paling,   which  is  to  be   exposed  to  the  vicissitudes  of  the 
w^eather,  and  the  rotting  agency  of  wet  and  frost  alternating 
with  drought,  he  uses  the  hardest  and  toughest  woods  that 
he  can  get — mahogany,  teak,  and  oak,  the  product  of  trees 
of  the  slowest  growth.     He  finds,  in  short,  that  the  product 
w^hich  results  from  the  longer,  slower,  and  more   gradual 
process,  is  more  stable  and  of  longer  endurance  than  that 
which  is  produced  more  rapidly.     The  gourd  which  springs 
up  from  a  seed,   covers  yards  of  ground  with  its   foliage, 
flowers,  and  fruits,  all  within  a  couple  of  months,  withers  in 
a  single  night,  and  rots  indistinguishably  into  the  earth  in  a 
fcAV  weeks.    The  iron-wood,  whose  annual  growth  is  scarcely 
appreciable,  and  w^hich  takes  a  century  to  mature,  is  so  hard 
as  to  turn  the  edge  of  steel  tools,   and  is   virtually  almost 
indestructible.     So  the  horse,  which  arrives  at  full  stature 
and  maturity  at  five  years  of  age,  is  senile  at  twenty  ;  man, 
who  requires  twenty  years  to  reach  maturity,  often  retains 
his  vigour  till  eighty,  and  the  elephant,  w^hich  does  not  attain 
its  full  growth  till  thirty,  lives  considerably  more  than  a 
century.     It  is  the  same  wdth  other  things — with  all  things. 
The  business  which  has  existed  for  long,  and  has  been  handed 
down  from  father  to  son  for  generations,  survives  the  panics 
Avhich  ruin  the  firms  of  yesterday.     "  Light  come,  light  go  " 
has  become  a  proverb,  indicating  the  ease  with  which  for- 

13 


17^  SANITY    AND    INSANITY. 

tunes  rapidly  accumulated  are  rapidly  dispersed.  The  jerry- 
built  house,  which  is  run  up  in  three  months,  is  scarcely 
complete  before  it  begins  to  decay ;  while  the  house  which  is 
soundly  built  is  also  built  slowly.  The  construction  of  the 
plans  is  a  slower  process.  The  concrete  foundations  are 
allowed  time  to  consolidate  before  the  superstructure  is 
raised  upon  them';  the  wood  has  been  allowed  time  to 
season  before  it  is  used  ;  the  bricks  have  been  burnt  slowly 
to  get  them  uniformly  hardened  ;  the  mortar  is  allowed 
time  to  set  before  weights  are  placed  on  it  ;  the  paint  is 
allowed  time  to  dry  before  another  coat  is  applied.  The 
newspaper  article  which  is  forgotten  five  minutes  after  it  is 
read,  was  scribbled  off  at  high  pressure  in  a  few  minutes  while 
the  printer's  devil  was  waiting  for  copy  ;  the  book  which  lasts 
for  generations  and  is  read  by  posterity,  is  the  result  of  the 
labour  and  thought  of  years.  The  more  slowly  glass  is 
annealed,  the  less  brittle  it  becomes.  To  get  vegetables 
tender  and  succulent  it  is  necessary  to  grow  them  on  rapidly  ; 
those  that  are  slow  in  growing  are  always  tough  and  stringy. 
When  the  Oklahoma  territory  was  first  colonized  by  the 
United  States,  a  town  grew  up  in  a  single  night — a  town  with 
its  drinking-bars,  post-office,  newspaper,  and  bank  complete. 
In  a  week  the  town  was  gone,  its  shanties  ruined,  and  its 
streets  desolate.  Such  things  do  not  happen  in  an  old 
country.  An  English  hamlet  of  but  a  dozen  houses  remains 
year  after  year,  decade  after  decade,  century  after  century  ; 
for  it  has  grown  gradually  to  be  what  it  is.  As  to  changes 
in  the  ^veather,  it  has  passed  into  a  proverb  that  "  Long 
foretold,  long  last ;  short  notice,  soon  past."  Throughout 
the  whole  universe  both  of  nature  and  of  art,  the  law  is 
always  true,  that  "  the  slow  alone  shall  last,  and  the  gradual 
only  endure."  It  would  be  strange  indeed  if  in  one  isolated 
province  of  nature  this  law,  otherwise  universal,  did  not 
obtain,  and  if  those  highest  nervous  regions  which  have 
developed  rapidly,  and  attained  completion  by  leaps  and 
bounds,  were  not  more  unstable,  and  more  easily  disordered 
and  disintegrated,  than  those  which  have  attained  maturity 


THE   CAUSES   OF    INSANITY.  1 79 

by  a  more  gradual  process.  As  a  matter  of  fact  it  is  found 
that  in  this,  as  in  other  provinces  of  nature,  the  law  holds 
good. 

When  we  increase  the  rate  at  which  the  development  of 
an  organism  proceeds,  the  results  of  the  development  are 
less  stable,  are  more  easily  varied  and  disordered  than  when 
development  proceeds  more  slowly.  Thus  we  find  that 
domesticated  animals,  in  which  the  capacity  to  mature  early 
has  been  implanted  by  cross-breeding,  and  carefully  nursed 
by  selection,  are  far  more  prone  to  vary,  are  less  uniform  in 
character,  resemble  one  another  far  less  closely  than  wild 
animals  of  the  same  species  whose  development  is  more 
gradual  ;  and  we  find,  moreover,  that  domesticated  animals 
are  more  subject  to  disease  than  Avild  ones.  The  tendency 
of  precocious  children  to  die  young  has  become  a  matter  of 
notoriety.  But  the  most  frequent  and  most  conspicuous 
result  of  an  undue  rapidity  of  development,  and  especially 
of  the  last  stages  of  development,  is  unstability  of  the 
highest  nervous  arrangements.  We  have  seen  that  a  cer- 
tain degree  of  instability  is  essential  to  the  constitution  of 
the  nervous  system,  and  without  this  instability  it  cannot 
act.  Hence  it  will  naturally  happen  that  when  the  organism 
as  a  whole  is  less  stably  constituted  than  usual,  the  increase 
of  instability  will  be  especially  marked  in  that  tissue  which 
is  normally  less  stable  than  the  rest.  If  the  nervous  system, 
and  especially  its  highest  regions,  be  more  than  usually  un- 
stable, what  will  be  the  result  ?  Broadly  speaking,  the 
results  will  be  as  follows. 

The  normal  instability  being  increased,  the  normal  dis- 
charges will  take  place  on  less  provocation  than  in  more 
stably  constituted  individuals.  Reaction  will  take  place  on 
slighter  impressions.  Hence  we  find  that  cross-bred  animals, 
which  are  distinguished  on  the  one  hand  by  early  maturity, 
that  is  to  say  by  rapid  development,  are  distinguished  also 
by  their  wildness.  "  Thus  the  Earl  of  Powis  formerly 
imported  some  thoroughly  domesticated  humped  cattle  from 
India,  and  crossed  them  with  English  breeds,  which  belong 


l8o  SANITY   AND   INSANITY. 

to  a  distinct  species  ;  and  his  agent  remarked  to  me,  without 
any  question  having  been  asked,  how  oddly  wild  the  cross- 
bred animals  were."  "  Sir  F,  Darwin  crossed  a  sow  of  the 
latter  [Chinese  domesticated]  breed  with  a  w^ild  Alpine  boar 
which  had  become  extremely  tame,  but  the  young,  though 
having  half-domesticated  blood  in  their  veins,  were  extremely 
wild  in  confinement.'-  "  Captain  Hutton,  in  India,  crossed 
a  tame  goat  with  a  wild  one  from  the  Himalayas,  and  he 
remarked  to  me  how  surprisingly  wild  the  offspring  were." 
The  same  peculiarity  has  been  noticed  in  pheasants,  fowls, 
ducks,  finches,  and  other  animals.^  Now  the  character  which 
distinguishes  wild  animals  from  tame  ones  is  their  much 
more  energetic  reaction  to  slight  impressions.  The  snapping 
of  a  twig,  a  distant  footstep,  a  whiff  of  scent  from  an  animal 
passing  far  away,  is  enough  to  make  the  wild  animal  start 
up  on  the  alert,  to  put  every  muscle  in  his  body  in  a  state  of 
tension  in  readiness  for  instant  flight,  or  to  scare  him  into 
headlong  activity.  The  tame  animal,  on  the  other  hand,  will 
bear  to  be  approached,  spoken  to,  patted,  scratched,  and 
punched  without  being  roused  out  of  his  sluggish  content- 
ment. 

Not  only  will  the  more  rapidly  developed,  and  therefore 
more  unstable,  organism  react  to  slighter  impressions  than 
the  slower  growing  and  more  stable  individual,  but  to  im- 
pressions of  the  same  intensity  the  former  will  react  more 
vigorously.  Hence  they  will  be  generally  of  greater  activity, 
capable  of  stronger,  more  rapid,  and  more  sustained  move- 
ment than  the  stably  constituted  organism.  The  wildness 
of  crossed  species,  which  is  from  one  point  of  view  a  re- 
action to  slighter  impressions,  is  from  another  point  of  view 
a  more  vigorous  reaction  to  impressions  of  equal  intensity. 
The  crossing  of  varieties  and  races  and  "  strains  "  produces 
invariably,  with  the  increase  of  size  and  the  earlier  maturity, 
on  which  we  have  already  insisted,  an  increase  of  vigour  in 

'  Darwin,  "Variation  of  Animals  and  Plants  under  Domestication," 
1875,  vol.  ii.  p.  19. 


THE   CAUSES   OF    INSANITY.  l8l 

the  offspring  ;  that  is  to  say,  an  increase  in  the  energy  of 
their  reaction  to  impressions. 

From  our  present  point  of  view,  the  most  important  result 
of  an  undue  rapidity  of  the  process  of  development  is  the 
structural  instability  of  the  tissues  so  developed.  When  the 
highest  nerve  regions  attain  completion  very  early  in  life  as 
the  result  of  an  unduly  rapid  development,  they  will  be  un- 
duly liable  to  derangement  upon  slight  provocation  ;  and 
hence  we  find  that  very  precocious  children  are  very  liable 
to  nervous  disorders  ;  and  that  such  individuals,  on  attaining 
adult  age,  are  very  liable  to  insanity.  "  There  be  some," 
says  Bacon,  "  have  an  over  early  ripeness  in  their  years, 
which  fadeth  betimes." 

There  is  yet  another  aspect  of  this  subject  that  has  to  be 
considered.  Height  of  intelligence  depends  in  the  main 
upon  height  of  development  ;  but  one  element  in  high 
intelligence  is  the  readiness  with  which  the  higher  regions 
of  the  nerve  tissue  undergo  rearrangement.  The  more 
easily  new  combinations  of  cells  and  fibres  are  formed,  the 
more  readily  new  channels  can  be  excavated  in  the  grey 
matter,  the  greater  the  facility  with  which  rearrangements 
and  recombinations  are  effected,  the  more  easily  can  new 
courses  of  conduct  and  new  modes  of  thought  be  originated, 
and  the  more  complex  are  the  reactions  that  the  individual 
can  effect  upon  his  circumstances.  Now  this  readiness  to 
undergo  rearrangement  is,  of  course,  in  other  terms,  mobility 
or  instability  of  the  nerve  tissue,  and,  as  such,  is  greatly 
favoured  by  rapidity  of  development.  Rapidity  of  develop- 
ment, as  it  is  a  factor  in  the  production  of  insanity,  is  also 
therefore  a  factor  in  the  production  of  high  intelligence,  and 
thus  there  is  a  sound  scientific  basis  for  the  saying  of  Dryden 

that— 

"  Great  wits  to  madness  sure  are  near  allied, 
And  thin  partitions  do  their  bounds  divide." 

Hence  we  shall  expect  to  find  that  those  individuals  who 
develop  rapidly  will  as  a  rule  be  more  intelligent  than  those 
who  develop  slowly,  and  this  we  find  to  be  the  case  ;  for,  as 


1 82  SANITY   AND   INSANITY. 

a  rule,  it  is  undoubted  that  the  intelhgent  child  makes  the 
clever  man  and  the  backward  child  the  dull  man.  The  rule 
is  of  course  not  without  exceptions,  for,  as  we  have  already 
seen,  height  of  intelligence  depends  essentially  on  extent  of 
development,  and  the  more  rapid  process  of  development 
does  not  necessarily  proceed  further  than  the  slower  one. 
Hence  we  sometimes  come  across  an  individual  who  was  dull 
in  childhood  and  youth,  and  developed  later  in  life  a  high 
degree  of  intelligence.  In  such  individuals  the  intelligence 
will  be  of  very  stable  and  enduring  character. 

On  every  hand  we  have  evidence  of  the  truth  of  our  main 
proposition,  that  the  more  rapid  the  development  of  the 
highest  nervous  centres,  the  less  stable  is  the  result.  We 
have  now  to  notice  that  this  instability  may  reach  so  high  a 
degree  as  to  surpass  the  limits  of  the  normal.  The  reaction 
to  impressions  may  be  so  vigorous  as  to  be  manifestly  in 
excess  :  conduct  may  become  outrageous.  Or,  to  put  it 
more  accurately,  a  certain  amount  of  decomposition  of  the 
nerve  tissue  we  have  seen  to  be  necessary  for  the  performance 
of  the  function  of  that  tissue.  This  decomposition  is  in 
normal  organisms  prevented,  by  the  inherent  stability  of 
their  tissue,  from  occurring  in  excess.  But,  when  the  tissues 
are  unduly  unstable,  and  the  check  on  its  progress  is 
diminished,  it  may  easily  take  place  in  such  excess  as  to 
produce  actual  disorganization  of  the  highest  nervous 
regions  ;  which  disorganization  is,  as  we  have  seen,  the 
physical  defect  which  underlies  insanity.  Doubtless  it  some- 
times, though  rarely,  happens  that  an  organism  developes 
with  great  rapidity  and  yet  presents  no  evidence  or  no 
striking  evidence  of  instability  ;  but  this  may  be  accounted 
for  by  its  possession  of  what,  for  want  of  a  better  term,  I 
must  call  momentum.  We  have  already  seen  how  the 
heavy  ball,  from  its  greater  momentum  presses  steadily 
forwards  when  the  light  one,  proceeding  at  even  a  higher 
velocity,  is  diverted  from  its  course  ;  and  similarly  a  railway 
train  that  is  to  travel  at  a  very  high  speed  is  made  very 
heavy.     If  it  is  too  light  it  will  be  apt  to  run  off  the  line. 


The  causes  of  insanity.  183 

There  seems  to  be  some  analogous  property  in  developing 
organisms  which  enables  those  which  possess  it  in  a  high 
degree  to  proceed  straight  onward  in  spite  of  a  high 
velocity,  while  those  in  which  it  is  Avanting  are  easily  diverted 
from  their  course. 

The  conclusions  at  which  we  arrive  with  regard  to  the 
bearing  of  the  second  law  of  inheritance  upon  the  production 
of  insanity  are  therefore  these  : — 

1.  When  the  germ  starts  upon  its  course  of  development 
with  an  insufficient  impetus,  the  development  of  the 
organism  in  general,  and  the  highest  nervous  regions  in 
particular,  will  be  incomplete  ;  and  this  incompleteness, 
when  slight,  will  show  itself  as  feebleness  of  mind,  when 
considerable  as  imbecility,  and  when  extreme  as  idiocy.  A 
still  greater  defect  in  the  impetus  will  result  in  the  non- 
production  of  living  offspring. 

2.  When  the  impetus  given  to  the  germ  is  such  that 
development  proceeds  with  undue  speed,  the  later  stages 
will  be  apt  to  be  faulty,  and  the  organism  so  developed  will 
be  unstable,  and  will  be  prone  to  insanity. 


CHAPTER  VII. 

THE    CAUSES    OF    INSANITY    {Coiltmucd). 

Direct  Stress. 

It  was  said  at  the  outset  of  the  preceding  chapter  that 
every  individual  has  his  breaking-point  ;  that  is  to  say,  that 
if  you  subject  him  to  sufficient  stress  he  will  become  insane. 
The  amount  of  stress  that  his  highest  nerve  regions  will  be 
able  to  bear  before  breaking  down,  depends  on  the  stability 
of  constitution  which  he  has  derived  from  his  parentage  and 
ancestry,  as  already  considered.  It  now  remains  to  consider 
the  complementary  factor,  and  to  enumerate  and  describe 
the  various  stresses  to  which  men  and  women  are  subject, 
and  which  make  for  the  production  of  insanity. 

The  stresses  which  act  on  and  tend  to  disorder  the 
highest  nerve  regions  are  divisible,  first,  into  the  direct  and 
the  indirect  ;  the  former  being  produced  by  the  action  of 
some  noxious  agent  immediately  upon  the  centres  themselves, 
the  latter  by  agents  acting  on  the  peripheral  ends  of  the 
nerves,  and  setting  up  currents,  which  break  upon  the 
highest  nerve  regions,  and  by  some  abnormal  element  of 
volume  or  intensity,  so  act  on  these  regions  as  to  produce 
disorder  in  them. 

The  direct  stresses  arise  either  from  the  direct  application 
of  mechanical  violence  by  blows  on  the  head,  or  from  in- 
flammation of  the  brain  itself,  or  the  parts  immediately 
adjacent,  as  in  meningitis,  or  from  pressure  by  the  rupture 
of  a  blood-vessel,  and  the  escape  of  blood  into  the  rigid 
chamber  of  the  skull,  or  from  the  pressure  of  a  tumour,  or 


THE    CAUSES    OF    INSANITY.  lof 

from  actual  destruction  by  the  ploughing-up  of  the  brain 
tissue  by  a  blood-clot,  or  by  the  encroachment  of  a  tumour, 
or  from  the  influence  on  the  highest  nerve  regions  of  some 
alteration  in  the  blood  which  bathes  them.  It  is  easy  to 
understand  how  readily  a  structure  of  such  extreme  delicacy 
and  sensitiveness  as  that  of  the  highest  nerve  regions,  can 
have  its  action  altered  and  disordered  by  any  alteration  of 
deleterious  character  in  the  composition  of  the  blood  in 
which  it  lies,  and,  as  it  were,  soaks. 

The  indirect  stresses  are  of  two  kinds  :  first,  those  in 
which  the  agent  is  some  commotion  in  the  organism  itself, 
acting  on  the  visceral  nerves  and  producing  an  alteration 
in  those  internally  initiated  currents  whose  wash  upon  the 
shore  of  the  highest  centres  we  have  already  discovered  to 
be  the  foundation  of  the  coencesthesis.  Such  internal  com- 
motions may  be  either  general,  accompanying  some  change 
which  aff'ects  the  whole  of  the  body,  such  as  those  which 
takes  place  at  puberty,  at  the  climacteric,  and  in  pregnancy  ; 
or  it  may  be  a  local  aff'air,  some  local  lesion,  an  ulcer  of 
stomach  or  intestine,  or  tuberculosis  of  lung,  or  disease  of 
bladder  or  other  organ. 

Lastly,  there  are  the  stresses  of  external  origin,  those 
produced  by  agents  or  events  in  the  environment  acting  on 
the  highest  nerve  regions  through  the  ordinary  channels  of 
the  special  senses,  the  ingoing  nerves  and  the  lower  and 
intermediary  centres.  Such  are  the  so-called  moral  causes 
of  insanity,  adverse  circumstances,  worries,  anxieties,  and 
troubles  of  various  kinds. 

The  direct  stresses  differ  from  the  indirect  mainly  in  this, 
that  from  the  character  of  their  action,  from  the  immediate- 
ness  of  their  application  to  the  highest  nerve  regions,  their 
effect  is  so  powerful,  that  no  nervous  system,  however  stably 
constituted,  can  resist  them.  While  no  indirect  stress  of 
ordinary  intensity  can  produce  insanity  by  its  action  on  a 
nervous  system  of  normal  stability  ;  and  while  it  is  doubtful 
whether  an  indirect  stress,  of  however  great  intensity,  can 
produce  insanity,  unless  the  nervous  system  on  which  it  acts 


1 86  SANITY    AND    INSANITY. 

is  predisposed,  by  inherited  instability  of  constitution,  to 
become  disordered  ;  there  is  no  nervous  system,  however 
soundly  or  stably  constituted,  which  is  able  to  withstand  the 
influence  of  a  direct  stress  of  even  moderate  severity.  It 
takes  a  harder  knock  on  the  head  to  stun  one  man  than  to 
stun  another  ;  but  if  you  only  hit  hard  enough,  you  can 
stun  the  strongest  and  sturdiest  man  alive. 

The  first  of  the  direct  stresses  that  has  to  be  considered 
is  that  of  blows  on  the  head.  Wounds  of  localized  portions 
of  the  brain  we  need  not  consider,  for  their  effect  is  local, 
and  any  general  symptoms  of  involvement  of  a  large  area 
arise  as  a  consequence  of  the  secondary  effect  of  inflammation, 
which  will  be  considered  subsequently.  At  present  we  are 
concerned  with  those  blows  only,  which  are  widely  dis- 
tributed, and  have  a  general  effect,  such  as  are  inflicted  by 
heavy  and  blunt  instruments,  or  such  as  result  from  falls. 
The  effect  of  such  a  blow  is,  of  course,  to  produce  a  violent 
shake  of  the  whole  contents  of  the  skull.  The  brain  is 
knocked  against  its  bony  case,  and  the  several  parts  of  the 
brain,  firmly  and  carefully  as  they  are  tied  and  fixed  in  their 
several  positions,  are  violently  jolted  against  one  another. 
The  local  effects,  the  bruising,  the  effusion  of  small  patches 
of  blood,  we  may  neglect,  and  may  confine  ourselves  to  the 
general  effect  of  such  a  shake  on  the  constitution  of  the 
nerve  centres.  The  effect  will  be,  that  not  only  is  the  mass 
of  the  brain  shaken  about  ;  not  only  are  the  hemispheres, 
convolutions,  and  great  masses  of  grey  and  white  matter 
jolted  and  banged  against  each  other,  but  the  molecules  also, 
the  fine  particular  structures  of  the  brain,  are  shaken  up, 
jolted  against  one  another,  and  displaced. 

We  have  already  seen  how  the  oldest  and  most  funda- 
mental arrangements  of  the  nervous  tissue  are  also  the 
most  completely  organized  ;  that  is  to  say,  the  most  firmly 
and  compactly  fixed  "in  their  places,  while  the  newest 
are  retained  in  position  by  the  weakest  and  slenderest 
ties.  Hence,  if  the  brain  is  subjected  to  a  general  shake, 
the    most    recently    organized    portions    will    suffer    most, 


THE    CAUSES   OE    INSANITY.  1B7 

and  the  oldest  and  most  firmly  compacted  will  suffer 
least.  Now  the  most  recently  organized  portions  of  the 
brain  are  those  whose  action  is  accompanied  by  conscious- 
ness ;  the  oldest  have  no  such  accompaniment,  and  the 
middle  portion  has  a  dim,  partial,  or  twilight  consciousness 
attending  its  action.  Hence  if  the  blow  on  the  head  is  very 
severe  indeed,  the  resulting  commotion  will  be  so  great 
that  even  the  most  firmly  compacted  arrangements  will  be 
disorganized,  the  nervous  arrangements  which  actuate  the 
heart's  movements  will  be  broken  up,  the  heart  will  cease 
to  act,  and  the  man  will  drop  dead.  If  the  blow  is  less 
severe,  so  as  to  derange  the  upper  and  middle  areas,  while 
leaving  the  lower  capable  of  acting,  the  man  will  live  on, 
but  since  that  portion  of  the  brain  whose  action  has  a 
conscious  accompaniment  is  out  of  gear  and  out  of  action, 
consciousness  will  cease.  The  man  will  be  stunned.  At  the 
same  time  that  the  conscious  accompaniment  of  their  action 
is  abolished,  the  results  of  the  action  of  these  centres — their 
functions — will  also  be  abolished,  and  their  functions  are  to 
actuate  conduct  and  movements  generally,  so  that  conduct 
and  movement  will  be  annulled  at  the  same  time  that 
consciousness  is  lost.  Observe,  not  because  consciousness  is 
lost,  but  at  the  same  time  and  for  the  same  reason.  If  the 
blow  is  still  less  severe,  so  as  to  derange  considerably  only 
the  topmost  of  the  nervous  centres,  consciousness  will  not 
be  altogether  lost.  Much  will  be  lost  indeed,  but  some  will 
be  retained.  A  twilight  consciousness  of  more  or  less  in- 
tensity will  remain,  and  the  man  will  be  dazed  and  confused, 
but  not  insensible.  Correspondingly,  conduct  and  move- 
ments will  not  be  abolished,  but  they  will  be  disordered. 
The  sufferer  will  not  fall  senseless  and  motionless,  but  he 
will  stagger  and  grope  about,  bewildered. 

The  molecules  which  have  been  thus  shaken  up  and 
disturbed  will  gradually,  as  time  elapses,  tend  to  return, 
and  will  in  great  measure  return  to  their  former  positions. 
Here  again  see  the  advantage  of  a  mobile  equihbrium. 
Stick  the  point  of  a  teetotum  into  the   ground,  and   it  Avill 


1 88  SANITY   AND   INSANITY. 

stand  upright,  but  now  give  it  a  knock,  and  over  it  goes, 
never  to  rise  again.  But  set  the  teetotum  spinning,  and 
again  it  stands  upright,  not  quite  so  steadily,  but  still  it 
stands.  Now  give  it  a  knock  and  see  what  happens.  A 
much  slighter  knock  suffices  now  to  disturb  its  equilibrium, 
and  make  it  sway  about  ;  but  when  it  has  been  knocked 
out  of  the  perpendicular,  it  returns  to  it  again  and  again. 
It  may  be  depresssed  until  its  stem  becomes  actually 
horizontal,  and  still  it  won't  fall.  The  same  advantages  are 
gained  by  the  mobile  equilibrium  in  which  the  nervous 
molecules  are  arranged.  They  are  more  easily  knocked  out 
of  their  places  than  those  of  a  bit  of  iron,  it  is  true,  but 
when  you  have  made  a  dent  in  the  iron  it  remains  for  ever, 
and  does  not  tend  of  itself  to  fill  up  ;  while  the  nervous 
molecules,  when  they  have  been  displaced,  tend,  unless  they 
have  been  altogether  dislocated,  to  return  to  their  old 
positions.  It  is  natural  that  those  which  have  been  more 
deeply  organized,  more  firmly  compacted  in  their  places, 
should  have  been  displaced  to  the  least  extent,  and  should 
be  the  first  to  regain  their  old  positions.  So  that  we  find 
breathing  recovers  first,  then,  as  consciousness  begins  to 
glimmer,  the  simple  movements  become  possible,  the 
patient  groans  when  disturbed,  and  opens  his  eyes  when 
questioned.  Then  the  daylight  of  consciousness  broadens 
and  brightens,  the  man  begins  to  be  aware  of  where  he  is, 
to  recognize  his  surroundings,  to  stir  uneasily  on  his  couch 
and  to  move  his  arms.  Then  he  is  able  to  get  up  and 
stagger  about,  and  his  mind  has  returned  in  great  part,  but 
he  is  still  confused  and  dazed  ;  and  at  length  he  becomes 
completely  conscious  and  capable  once  more. 

The  tendency  of  the  molecules  to  return  to  their  old 
places  depends,  as  we  have  seen,  on  the  strength  of  the  tie 
Avhich  binds  them  there.  This  tie  depends  in  every  one 
on  the  completeness  of  the  organization  of  the  particular 
nervous  arrangement,  that  is  to  say  on  the  length  of  time  it 
has  been  in  existence  and  the  number  of  times  it  has  been 
in  action.     But  in  some   people  and    in    some    brains    the 


THE   CAUSES   OF    INSANITY.  1 89 

strength  of  this  tie  is  stronger  than  in  others.  Some 
nervous  systems  are  stable  and  others  unstable.  Hence  the 
tendency  of  the  molecules  to  return  to  their  places  will  vary 
in  different  people,  in  some  being  strong  and  in  others  weak. 
In  either  case  those  arrangements  will  be  the  last  to  return 
and  will  find  the  most  difficulty  in  returning,  will  be  most 
prone  not  to  return  at  all,  which  are  the  newest,  and  there- 
fore the  least  completely  organized,  and  the  least  firmly 
settled  in  their  new  positions.  A  blow  on  a  strong  and 
stable  brain  may  stun,  and  then,  as  the  molecules,  after  their 
shake,  return  to  their  old  positions,  and  consciousness 
returns,  it  may  be  found  that  the  very  last  and  newest  of 
all  the  arrangements,  those  into  which  the  molecules  have 
fallen  during  the  few  minutes  or  hours  preceding  the  blow, 
fail  to  return  to  their  places.  They  were  shaken  completely 
out  of  their  orbits  and  have  failed  to'return  to  the  arrange- 
ment, new  and  frail  and  unorganized  as  it  was,  in  which 
they  existed  just  before  the  accident  occurred.  In  such  a 
case  the  patient  will  lose,  with  the  nervous  arrangement 
that  events  produced  in  him,  the  memory  of  the  events. 
He  will  remember  everything  that  happened  up  to  a  certain 
time  before  the  accident,  a  time  sufficient  to  allow  the  new 
arrangements,  produced  by  the  action  of  passing  events,  to 
consolidate  and  settle  ;  but  those  nervous  arrangements  of 
more  recent  production  will  be  hopelessly  lost. 

The  same  blow  falling  upon  a  brain  whose  arrangements 
were  less  stable,  whose  molecules  were  retained  in  their 
orbits  by  a  less  powerful  attraction,  might  easily  produce  a 
more  profound  disorganization.  In  such  a  case  certain  of 
the  arrangements  might  be  retained  to  a  high  level  and 
others  lost  to  a  comparatively  low  one,  some  might  be  com- 
pletely disorganized,  others  disarranged  in  various  degrees. 
So  that  when  some  order  was  restored  ;  when  the  excessive 
and  hyperbolic  swing  of  the  molecules  produced  by  the 
blow  had  settled  down  into  a  gyration  more  nearly  approach- 
ing the  normal  ;  when  such  of  the  higher  centres  as  were 
not  completely  disorganized   resumed  their  function  ;  and 


iqo  SANITY   AND   INSANITY. 

such  as  were  injured  and  altered  had  resumed  what  function 
they  were  capable  of ;  it  would  be  found  that  the  state  of 
that  person's  consciousness  was  now  completely  different 
from  what  it  had  been  before  ;  it  would  be  found  that  the 
same  circumstances  acting  on  the  altered  structure  would 
eYoke  an  altered  reaction,  that  the  damaged  and  defectiYe 
structure  was  no  longer  capable  of  acting  normally.  If  the 
damage  were  local  and  were  confined  to  a  low  level  in  the 
nervous  hierarchy,  then  there  would  be  paralysis  without 
insanity  ;  but  if  it  were  more  general  and  more  diffused  over 
the  higher  regions,  then  the  result  of  the  blow  would  be  to 
produce  insanity  ;  and  thus  are  explained  those  cases  of 
insanity  whose  origin  is  directly  traumatic. 

Next  to  blows  we  may  consider  a  frequent  consequence 
of  blows — inflammation.  Acute  inflammation  of  the  brain- 
substance  itself,  is  very  rare.  Practically,  the  only  acute 
inflammation  within  the  skull  with  which  we  are  ac- 
quainted, is  that  which  affects  the  membranes.  The 
whole  of  the  surface  of  the  brain  is  covered  by  a 
filmy  cobweb-like  membrane  which  dips  down  into  all  the 
hollows  and  grooves  between  the  convolutions,  and  carries 
the  blood-vessels  for  the  supply  of  the  grey  matter  which 
lies  on  the  surface  of  the  brain.  Now  this  grey  matter 
on  the  surface  is  the  seat  of  the  highest  nerve  regions,  and 
hence  when  the  membrane  \vhich  lies  in  actual  contact 
with  it  is  inflamed,  it  can  readily  be  understood  that  the 
highest  nerve  regions  must  suffer  severely  in  structure 
and  in  action. 

Inflammation  of  the  membranes  of  the  brain  is  not 
usually  attended  by  active  insanity,  never  by  intelligent 
insanity.  The  invasion  of  the  disease  being  gradual,  and 
its  area  widespread,  the  conditions,  which  are  necessary  for 
the  occurrence  of  active  insanity,  do  not  exist,  and  active 
insanity  does  not  occur.  There  is,  however,  a  condition  of 
hebetude,  dullness,  and  inactivity,  which  is  the  equivalent 
of  dementia  ;  which  is,  in  fact,  a  dementia  of  sudden  origin 
and    rapid    course.      This    hebetude   quickly    deepens    into 


THE    CAUSES    OF    INSANITY.  I9I 

Stupor  ;  and  the  stupor  passes  in  a  few  days  into  coma  ; 
showing  that  the  disorder  takes  the  classical  course  of  in- 
volving the  nerve  centres  and  regions  in  their  order  from 
above  downwards,  and  thus  is  assimilated  in  its  main 
features  to  insanity,  although,  since  the  bodily  disorders 
are  so  much  more  prominent,  it  is  not  looked  upon  clinically 
as  a  case  of  disorder  of  mind.  It  is  necessary  to  guard 
against  being  misled  by  superficial  differences,  and  against 
failure  to  recognize  the  identity  of  fundamental  nature  that 
exists  between  maladies  that  are  usually  treated  by  different 
methods,  and  regarded  from  different  points  of  view.  An 
inflammatory  process  in  the  membranes  and  superficial  parts 
of  the  brain,  if  widespread  and  intense,  will  rapidly  and 
completely  obliterate  the  functions  of  the  nerve  tissue  to  a 
considerable  depth,  and  so  will  produce  a  condition  of 
stupor,  deepening  into  coma.  The  same  process,  if  more 
limited  and  less  acute,  will  act  more  slowly.  An  interval 
will  elapse  between  the  removal  of  the  highest  centres  and 
that  of  those  beneath  them.  During  this  interval  the 
centres  beneath  the  highest  will  be  free  to  act  without  the 
control  of  their  superiors,  and  such  uncontrolled  action  will 
show  itself  in  delirium.  Hence,  in  meningitis  delirium  is 
common.  If  now  the  factors  are  slightly  rearranged  ;  if  the 
process  is  still  less  intense  ;  if  the  mode  of  invasion  of  the 
disease  is  of  such  a  character  that  but  a  thin  paring,  as  it 
were,  is  taken  off  the  highest  regions  of  the  brain,  and  the 
immediately  subjacent  area  not  only  overacts,  but  overacts 
very  strenuously  and  energetically,  then  the  symptoms 
exhibited  will  not  be  those  of  stupor,  as  in  the  first  case, 
nor  of  a  quiet  and  busy  delirium  as  in  the  second  case,  but 
there  will  be  a  violent  outburst  of  intense  excitement,  which 
will  take  the  form  of  acute  delirious  mania.  The  one 
patient  will  be  treated  at_home  or  will  find  ready  admission 
into  a  general  hospital,  and  will  come  under  the  care  of  a 
general  physician  ;  the  other  will  be  taken  to  a  lunatic 
asylum,  and  come  under  the  care  of  an  alienist.  The  two 
cases    will    be    studied   by    different    people   from;  different 


1 92  SANITY    AND    INSANITY. 

points  of  view,  and  will  be  described  in  different  books  ;  and 
hence  their  real  identity  of  nature  will  be  obscured  and 
overlooked  ;  it  is  necessary,  therefore,  the  more  strongly  to 
insist  that  the  maladies  are  in  reality  but  different  phases 
and  manifestations  of  the  same  disorder.  The  backward 
condition  of  our  knowledge  of  the  pathology  of  insanity  is 
owing,  beyond  all  doubt,  in  the  main  to  the  dissociation  of 
its  study  from  that  of  the  pathology  of  those  other  dis- 
orders of  the  nervous  system  which  come  under  the  notice 
of  the  general  physician  and  the  surgeon. 

The  stresses  that  are  produced  by  increase  of  the  normal 
intracranial  pressure,  whether  this  increase  of  pressure  be 
due  to  haemorrhage,  or  to  the  encroachment  of  a  tumour,  or 
to  the  formation  of  an  abscess,  or  to  other  cause,  need  not 
detain  us  long  ;  for  it  is  found,  as  a  matter  of  experience, 
that  such  increase  of  pressure  never  produces  active  insanity. 
The  effect  of  pressure  is  to  obliterate  the  cerebral  functions 
without  this  obliteration  having  much  complementary  over- 
action  as  an  accompaniment.  The  loss  of  function  is  felt, 
according  to  rule,  first  and  most  in  the  highest  regions,  and 
spreads,  according  to  the  same  rule,  gradually  downward  to 
the  lowest.  Hence  the  first  effect  of  increased  pressure  is 
dulness  of  mind  and  inactivity  of  body  ;  and  as  the  pres- 
sure increases,  the  dulness  deepens  and  passes  into  stupor, 
and  the  inactivity  increases  to  paralysis.  Then  the  stupor 
deepens  and  passes  into  coma,  and  the  paralysis  becomes 
universal,  so  that  the  apoplectic  state  is  reached  ;  lastly,  the 
coma  ends  in  death  by  failure  of  breathing,  in  the  classical 
order.  Whatever  over-action  there  is,  takes  place  on  a  low 
level  ;  signs  of  over-activity  of  the  higher  regions,  such  as 
delirium  or  mania,  are  never  exhibited  in  cases  of  simple 
intracranial  pressure  ;  but  the  absence  of  these  signs  of 
overaction,  and  the  conspicuousness  of  the  bodily  defects 
and  disorders,  must  not  blind  us  to  the  fact  that  the  effect 
of  this  form  of  stress  is  to  produce  a  gradual  obliteration  of 
both  mind  and  conduct,  which  is  fundamentally  the  same 
process  as,  when  spread  out  thin  and  extending  over  years 


THE   CAUSES   OF   INSANITY.  193 

instead  of  hours,  goes  by  the  name  of  dementia,  and  lands  its 
exhibitors  in  kinatic  asyhmis. 

The  next  form  of  stress — that  which  arises  from  altera- 
tions in  the  character  of  the  blood  which  bathes,  nourishes, 
and  clarifies  the  nervous  system — is  of  a  less  violent  and 
brutal  character  than  those  hitherto  considered  ;  but,  on 
the  other  hand,  its  operation  is  of  the  most  direct  descrip- 
tion, it  is  applied  in  the  most  immediate  and  intimate 
manner  to  the  nerv^ous  elements,  and  its  effect  is  propor- 
tionately immediate  and  great.  It  is  obvious  that  any 
alteration  in  the  constitution  of  the  blood  must  at  once 
affect  the  character  of  the  nutriment  supplied  to  the  higher 
nerve  regions,  must  affect  the  capacity  of  the  blood  to  carry 
from  these  regions  their  waste  material,  and  so  must  be 
liable  to  interfere  with  and  alter  their  working.  As  a  matter 
of  fact,  we  find  that  every  alteration  in  the  blood  is  at  once 
responded  to  by  a  modification  in  the  action  of  the  nervous 
system — a  modification  which  is,  of  course,  most  marked  in 
the  highest  regions  of  the  system. 

Take  first  the  simplest  alteration,  a  mere  defect  in  the 
blood  supply,  consequent  on  a  copious  haemorrhage.  If  a 
man  receives  a  severe  wound,  and  rapidly  loses  a  large 
quantity  of  blood,  what  is  the  result  ?  The  result  is  that 
he  faints.  He  falls  to  the  ground  unconscious  and  void  of 
spontaneous  movement.  Consciousness  and  conduct  are 
simultaneously  abolished  ;  and  the  abolition  of  conscious- 
ness and  conduct  means  the  abolition  of  the  function  of  the 
whole  of  the  nervous  hierarchy  down  to  a  low  level  of  rank. 
Or  suppose  that  the  blood,  instead  of  being  suddenly 
diminished  in  quantity  by  haemorrhage,  simply  ceases  to 
circulate,  by  failure  of  the  heart's  action.  The  result  is  the 
same — fainting  or  syncope  follows  at  once  ;  the  nerve  centres 
cease  to  act. 

Now  suppose  that  the  blood  is  deteriorated  in  quality,  is 
thinner  and  more  watery  than  normal,  is  in  fact  diluted,  as 
occurs  in  anaemia  ;  then  it  will  happen  that  the  nerve 
centres,  while  nourished  to  a  certain  extent,  are  not  well 

14 


194  SANITY    AND    INSANITY. 

nourished.  Their  pabulum  is  supphed  to  them  in  a  too 
dilute  and  attenuated  form,  and  their  nourishment,  and 
therefore  their  function,  suffers  in  consequence.  Their 
action  in  such  circumstances  is  feeble,  anergic,  sluggish.  If 
we  observe  a  person  suffering  from  anaemia,  we  see  in  the 
pallid  and  transparent  complexion,  in  the  pearly  hue  of  the 
white  of  the  eye,  and  in  the  pale  colour  of  the  lips,  evidence 
of  the  poverty  and  thinness  of  the  blood  ;  and  such  persons, 
we  notice,  are  inactive  ;  they  are  indisposed  to  exertion,  it 
is  difficult  to  rouse  them  to  full  working  order,  and  difficult 
to  maintain  them  in  full  activity.  Their  movements  are 
sluggish,  feeble,  and  unsustained.  If  we  turn  from  conduct, 
and  seek  evidence  of  the  state  of  their  minds,  we  find 
evidence  of  a  corresponding  condition.  They  are  never 
bright  in  intellect.  If  previously  of  alert  and  active  mind, 
they  become  slow  of  thought  and  feeble  in  expression. 
Often  they  will  sit  for  long,  inactive,  with  dropped  hands, 
gazing  at  vacancy.  Rouse  them  up  and  ask  them  what  they 
are  thinking  of,  and  they  will  appear  to  wake  and  come  to 
the  surface,  and  will  answer  "  Nothing  ; "  and  this  is,  no 
doubt,  approximately  true.  For  the  time,  consciousness, 
without  being  altogether  in  abeyance,  was  wanting  in  force, 
and  vividness,  and  brightness.  It  was  clouded  over.  In 
this  condition  of  dulled  activity  of  mind  and  body,  a  dul- 
ness  which  affects  only  the  highest  regions  ;  which  does  not 
affect  the  ordinary  and  habitual  adjustments  to  circum- 
stances ;  which  does  not  prevent,  although  it  renders  more 
difficult  and  laborious,  the  formation  of  new  adjustments  ; — 
we  see  just  that  amount  of  diminution  in  the  activity  of  the 
highest  nerve  regions  which  might  be  expected  to  result 
from  a  deterioration  in  the  quality  of  the  pabulum  supplied 
to  them. 

In  close  alliance  with  these  more  trifling  and  more  tem- 
porary cases  of  damage  to  the  function  of  the  highest  nerve 
region  from  loss  or  poverty  of  blood,  are  other  cases  in 
which,  from  reinforcement  of  other  unfavourable  conditions, 
the  damage  is  more  severe  and  more  lasting.     When  a  large 


THE    CAUSES   OF    INSANITY.  1 95 

quantity  of  blood  is   rapidly  lost,  as  when  a  large  artery  is 
wounded,   the  patient  not   only  faints,  but  often  he  has   a 
convulsion.     That   is  to  say,  the  higher  nerve  centres  cease 
to    act,    and    this   cessation    of    action    produces    universal 
paralysis,  and  is   accompanied  by  loss  of  consciousness,  so 
that  the  patient  falls  down  and  becomes  insensible.     But  it 
may  happen,  if  the  blood  is  lost  with  slightly  less  rapidity, 
or  if  the  nervous  system  is  naturally  slightly  more  unstable 
than  usual,  that,  instead  of  the  whole  functions  of  the  brain 
being   lost  at  once,  their  loss,  though  rapid,  it  may  be  very 
rapid,   is   yet   sufficiently  gradual  for  a  certain  order  to  be 
exhibited.     When  the  loss  takes  place  in  any  order,  it  is  the 
highest   faculties   that   are  first   lost  ;  and    throughout    the 
nervous    system    the    function    of     control,    restraint,    or 
inhibition,    is    always    higher    than    that    of    initiation    or 
activity,    since,    as  we   have    seen,    the  restraint  is    always 
exercised  by  a  centre  of  higher  rank  than  that  which  actuates 
the    movement.      Hence,    if    the    abolition    of   function   is 
extremely  rapid,  all  the  centres  will  be  affected  nearly  simul- 
taneously, and  instead  of  the    highest  centres  being  com- 
pletely lost  before  the  second  rank  is  attacked,  and  the  second 
completely  abolished  before  the  third  suffers,  it  will  happen 
that  all  the  centres  will  nearly  simultaneously  lose  first  their 
highest  function,  and  then  all  will  lose  their  lower  function, 
the  highest  centres  preceding  the  lower  in  their  loss  by  only 
a   small  interval.      The    result    of  the    sudden   and    nearly 
simultaneous  loss  of  their  highest  function — inhibition — by 
a  large  number  of  centres,  will  be  the  sudden  and  excessive 
overaction    of    a    large    number    of   centres,    the   outward 
expression  of  which  will  be  a  universal  convulsion. 

From  an  attack  of  convulsion  to  an  outbreak  of  mania 
is  but  a  short  step.  We  have  but  to  imagine  the  removal 
of  control  to  be  confined  to  the  higher  centres  instead  of 
being  universal,  and  to  be  of  more  gradual  character  ;  and 
the  consequent  overaction  to  take  place  in  those  centres 
only  which  are  just  below  the  highest  instead  of  through- 
out the  hierarchy,  and  to  be  of  more  gradual  character  also  ; 


196  SANITY   AND   INSANITY. 

and  the  outward  manifestation  will  be,  not  a  convulsion, 
but  an  outbreak  of  mania.  Hence  we  may  expect  to  find 
that  when  the  influence  acting  on  the  nervous  system  is 
not  of  the  sudden  and  extreme  character,  the  abrupt  arrest 
of  nourishment,  produced  by  a  great  and  rapid  loss  of  blood, 
but  is  of  more  deliberate  and  gradual  onset,  the  result  will 
be  an  outbreak  of  mania.  Hence  we  find  that  when  people 
are  dying  by  inches  from  the  effect  of  slow  and  small  but 
prolonged  haemorrhages,  the  last  stages  are  attended  by 
delirium.  Hence  in  death  from  starvation  maniacal 
delirium  usually  occurs  before  the  close. 

It  may  be  that  the  blood  is  of  sufficiently  good  quality, 
and  sufficiently  rich  in  nutritive  materials,  but  that  it  does 
not  reach  the  highest  nerve  regions  in  sufficient  quantity  ; 
and  in  such  cases  the  result  will  be  the  same  as  if  it  were 
deteriorated  in  quality  by  loss  or  starvation.  It  must  be 
remembered  that  the  highest  nerve  regions  are  the  last  to 
be  formed  ;  they  are  the  structures  of  latest  growth  ;  and 
not  only  is  their  intrinsic  composition  less  perfectly  organ- 
ized, and  on  that  account  more  liable  to  disturbance  than 
the  inferior  regions  ;  but  their  blood  supply  also  is  inferior 
in  the  stability  of  its  arrangements.  In  the  first  place  they 
are  in  point  of  distance  the  furthest  from  the  heart,  the 
centre  of  propulsion  of  the  circulation,  and  hence  any 
defect  in  the  propelling  power  of  the  heart  will  be  most  felt 
by  them.  In  the  second  place,  being  of  comparatively 
recent  formation,  their  blood  vessels  will  not  be  so  thoroughly 
well  formed  and  organized  into  adaptation  with  their  re- 
quirements as  those  of  older  tissues.  Hence,  on  both 
grounds,  any  defect  in  the  vigour  of  the  circulation  will 
make  itself  most  conspicuously  apparent  in  the  highest  nerve 
regions.  In  much  the  same  way,  the  water  supply  to  a  new 
house  will  be  more  likely  to  fail  than  that  to  an  older  one, 
on  account  of  defects  of  workmanship  and  miscalculations 
as  to  the  quantity  required  at  particular  places.  When  the 
house  has  been  inhabited  for  some  time,  any  irregularities 
and  defects  will   have  become  apparent,  and  will  have  been 


THE    CAUSES   OF    INSANITY.  1 97 

rectified.  If  the  house  is  not  only  new,  but  is  situated 
furthest  of  all  from  the  pumping  station,  then  it  is  evident 
that  any  weakness  in  the  pumps  will  be  most  severely  felt 
in  the  house  that  is  furthest  away.  For  these  reasons  we 
may  expect  that  not  only  in  conditions  in  which  the  blood 
is  deteriorated  in  quality,  but  also  in  diseases  in  which,  from 
failure  of  the  propelling  power  of  the  heart,  or  from  some 
obstacle  to  the  free  passage  of  the  blood  from  the  heart  to 
the  brain,  or  from  some  diversion  of  large  quantities  of  blood 
in  other  directions,  the  amount  of  blood  that  passes  through 
the  highest  nerve  regions  is  reduced  in  quantity,  in  such 
cases  evidence  of  disorder  of  mind  and  conduct  will  always 
be  present ;  and  when  the  blood  supply  is  greatly  diminished, 
the  disorder  of  mind  and  conduct  will  become  sufficiently 
conspicuous  and  sufficiently  great  to  amount  to  insanity. 
Hence  in  the  latter  stages  of  valvular  disease  of  the  heart, 
delirium  is  a  frequent  occurrence  ;  in  inflammation  of  the 
heart,  pericarditis  and  endocarditis,  it  occasionally  occurs. 
In  severe  attacks  of  bronchitis,  when  there  is  evidence  from 
the  blueness  of  the  lips  and  other  signs  that  the  blood  is 
passing  through  the  head  in  small  quantity  and  slowly,  some 
hebetude  and  lack  of  animation  is  always  present  ;  confusion 
of  mind  is  common  ;  and  delirium  is  of  occasional  occur- 
rence. 

Any  stress  which,  acting  on  a  brain  of  normal  stability, 
will  give  rise  to  hebetude,  confusion  of  mind,  and  light  or 
transient  delirium,  will,  if  it  acts  upon  a  brain  of  less  than 
normal  stability,  produce  the  same  effects  in  a  more  exag- 
gerated form,  and  thus  produce  insanity.  Hence  it  is  found 
that  while  in  every  case  of  heart  disease,  when  circulation 
at  length  fails,  signs  of  disorder  or  defect  of  mind  and  conduct 
become  apparent,  there  is  a  certain  proportion  of  cases  of 
heart  disease  in  which  the  disorder  of  mind  and  conduct 
amounts  to  actual  insanity  ;  and  these  are  the  cases  in  which 
the  defective  circulation  passes  through  an  unusually  un- 
stable brain.  Many  cases  have  been  recorded  in  which  the 
delirium  that  so  commonly  attends  pericarditis  lasted  not 


198  SANITY    AND    INSANITY. 

for  a  few  hours,  or  with  intermissions  and  remissions  for  a 
few  days,  but  for  weeks  and  months. 

From  stresses  arising  from  loss  of  blood,  from  deterioration 
in  the  quality  of  the  blood,  and  from  sluggish  or  defective 
circulation  of  the  blood,  the  transition  is  easy  to  those 
which  are  due  to  the  presence  in  the  blood  of  some  new 
and  deleterious  agent  or  ingredient — some  poison.  When 
we  remember  how  free  and  copious  is  the  supply  of  blood 
to  the  nervous  tissue  ;  how  large  and  numerous  are  the 
vessels  that  supply  the  brain  ;  how  marvellously  delicate 
and  attenuated  the  walls  of  the  small  capillary  vessels  in 
which  the  blood  is  distributed  among  the  nerve  elements  ; 
how  these  elements  are  fairly  bathed  and  soaked  in  the 
current  of  blood  ;  we  shall  recognize  how  direct  and  power- 
ful may  be  the  influence  on  these  elements  of  any  foreign 
substance  that  may  find  its  way  into  the  blood  ;  and  that 
when  this  foreign  substance  is  one  which  has  a  special  and 
peculiar  affinity  for  the  nerve  tissue,  and  is  absorbed  and 
assimilated  by  it  with  ease  and  even  avidity,  how  extremely 
powerful  is  the  stress  that  is  in  this  way  brought  to  bear. 
Moreover,  when  we  remember  how  easily  the  blood  absorbs 
these  poisons  ;  how  many  of  them  there  are  ;  how  they  may 
gain  access  to  the  blood,  not  only  in  the  food  and  drink 
through  the  stomach,  and  in  the  air  through  the  lungs  ; 
but  that  some,  when  once  introduced  into  the  blood,  may 
be  reinforced  and  invigorated  by  their 'own  multiplication  ; 
and  that  others  arise  actually  within  the  body  itself,  by  dis- 
integration of  its  own  tissues,  or  by  the  aberration  of  its 
own  processes  ; — when  we  bear  all  this  in  mind,  we  shall 
understand  the  frequency  with  which  stresses  of  this  kind 
are  brought  to  bear  on  the  nervous  system,  and  the  common- 
ness of  the  occurrence  of  disorders  of  mind  and  conduct  that 
are  owing  to  this  cause. 

The  number  of  the  deleterious  substances  which  act 
through  the  blood  upon  the  nerve  elements  is  large,  as  has 
been  said,  and  for  the  purpose  of  enumeration  it  will  be 
advisable  to  divide  them  according  to  their  source  of  origin. 


THE    CAUSES   OF    INSANITY.  1 99 

Among  those  which  arise  within  the  body  are  carbonic  acid, 
which  accumulates  in  the  blood  when  from  any  cause  it  is 
imperfectly  aerated.  This  happens  in  suffocation  from 
mechanical  causes,  such  as  strangulation,  or  from  occlusion 
of  the  windpipe  by  tumours  from  without,  or  growths  from 
within  ;  from  diseases  of  the  lungs,  which  prevent  the  blood 
that  passes  through  them  from  coming  in  contact  with  the 
air,  and  from  diseases  of  the  heart  and  disorders  of  the  circu- 
lation which  reduce  the  quantity  of  blood  that  passes  through 
the  lungs,  and  so  gets  a  chance  of  being  aerated.  Other 
poisons  of  internal  origin  are  those  of  uraemia,  which  ac- 
cumulates when  the  kidneys  are  not  acting  freely  to  separate 
from  the  blood,  and  discard  from  the  body,  those  effete 
matters  which  it  is  their  function  to  separate  ;  those  which 
remain  and  accumulate  in  the  blood  when  the  skin  fails  to 
perform  its  functions  ;  and  the  diabetic  sugar  which  passes 
into  the  blood  in  such  vast  quantities  in  certain  disorders  of 
the  liver.  In  this  group  must  come  also  the  poison  which 
is  absorbed  into  the  blood  from  a  seat  of  inflammation. 

The  group  of  poisons  that  find  their  way  into  the  body 
through  the  medium  of  the  air,  and  which,  after  their  ad- 
mission, increase  and  multiply  exceedingly,  are  those  of  the 
specific  fevers — the  poisons  of  small-pox,  scarlet  fever,  measles, 
typhus,  and  the  rest.  Others,  which  gain  entrance  in  the 
same  way,  but  do  not  subsequently  increase,  are  noxious 
vapours — coal  gas,  carbonic  acid,  carbonic  oxide,  foul  and 
unwholesome  odours  of  all  kinds. 

Of  the  poisons  which  get  into  the  blood  by  way  of  the 
stomach,  the  most  important,  because  the  most  frequent,  is 
alcohol  ;  which,  •  from  •  its  frequency,  from  the  ease  with 
which  the  dose  may  be  graduated,  from  its  diifusibility,  and 
the  consequent  rapidity  and  certainty  of  its  action,  affords 
by  far  the  most  favourable  opportunities  for  studying  the 
stresses  of  this  order,  and  may  be  taken  as  the  type  and 
example  of  them  all.  The  other  poisons  of  this  group  are 
innumerable.  They  include  the  whole  of  the  vegetable 
narcotic    poisons,  opium    and   its  constituents,  belladonna, 


200  SANITY   AND   INSANITY. 

hemlock,    henbane,    Indian    hemp,    stramonium,    haschish, 
and  many   others. 

Of  the  poisons  which  are  carried  to  the  nervous  system 
in  the  blood,  some  have  a  special'  power  of  selecting,  as  it 
were,  certain  parts  of  the  nervous  system,  and  of  acting  on 
those  parts  alone,  or  at  any  rate  with  greatly  preponderant 
activity.  Thus,  the  poisons  of  hemlock  and  curare  appear 
to  act  on  the  endings  of  the  nerves,  just  where  they  join 
the  muscles,  and  on  no  other  part.  Strychnia  acts  on  the 
spinal  cord  with  intense  energy,  but  does  not  perceptibly 
aiTect  other  portions  of  the  nervous  system.  With  poisons 
acting  in  these  ways  we  are  not  concerned.  The  whole 
group  of  narcotics,  however,  including  alcohol,  act  on  the 
nervous  system  after  the  classical  manner  so  often  indicated, 
and  remove  the  functions  of  the  centres  in  their  order  from 
above  downwards.  The  other  poisons — the  noxious  gases, 
the  poisons  of  fevers,  the  waste  products  of  the  bodily  pro- 
cesses, all  follow  the  same  rule  and  act  in  the  same  way. 
Although,  however,  they  follow  generally  the  same  rule, 
and  act  generally  in  the  same  way,  yet  among  these  also 
there  are  certain  differences  in  the  mode  of  action,  depend- 
ing, perhaps,  in  part  on  differences  of  affinity — preferences — 
for  certain  parts  of  the  higher  nerve  regions,  from  which  it 
happens  that  the  delirium  produced  by  one  particular  agent 
is  of  one  type,  and  that  produced  by  another  of  another. 
Thus  the  delirium  of  most  fevers,  and  that  of  chronic  alco- 
holism— delirium  tremens — has  gained  the  title  of  a  "  busy 
delirium."  The  patient,  with  earnest  and  preoccupied 
manner,  is  fumbling  and  searching  and  meddling  incessantly 
with  the  things  about  him.  In  belladonna  poisoning,  on 
the  other  hand,  the  delirium  is  of  a  joyous  cast.  These 
differences  are  slight,  however,  in  comparison  with  the 
general  uniformity  of  the  symptoms  produced  by  the  action 
of  the  different  stresses  of  this  class,  all  of  which  produce 
a  gradual  degradation  of  mind  and  conduct,  with  more  or 
less  of  the  complementary  overaction  on  a  lower  level,  which 
commonly  accompanies  this  degradation. 


THE   CAUSES   OF    INSANITY.  20I 

There  are  many  who  will  object  to  the  inclusion  of 
delirium  among  the  forms  of  insanity,  and  an  instance  has 
been  given  of  a  definition  or  description  of  insanity 
laboriously  constructed  so  as  explicitly  to  exclude  the 
delirium  of  fevers,  of  poisoning,  and  of  injury,  from  the 
denotation  of  insanity.  Although  of  course,  from  a  clinical 
point  of  view,  the  transient  delirium  of  fever  must  be  differ- 
ently regarded  and  differently  treated  from  the  prolonged 
delirium  of  insanity ;  yet,  looking  at  them  scientifically,  that 
is  to  say,  looking  at  their  fundamental  and  important 
similarities  and  differences,  it  is  abundantly  manifest  that 
the  former  are  comprehensive,  numerous,  important,  and 
pervading,  while  the  latter  are  limited,  few,  trivial,  and 
partial.  The  little  eddy  of  circling  air,  which  is  just  suffi- 
cient to  give  a  spiral  movement  to  the  dust  and  leaves  by 
the  roadside,  is  superficially  a  very  different  affair  from  the 
cyclone  which  uproots  a  forest  and  devastates  a  province  ; 
but  surely  both  belong  equally  to  the  science  of  meteorology, 
the  laws  of  being  and  action  are  the  same  in  both,  and  the 
one  can  be  fully  understood  only  by  being  considered  in 
connection  with  the  other.  When  France  declares  war 
against  Prussia,  because  Prussia  has  exercised  an  undue 
influence  in  European  politics,  the  action  is  superficially 
different  from  that  of  Styles  hitting  Noakes  in  the  eye 
because  Noakes  has  taken  more  than  his  fair  share  of  beer 
out  of  the  mug  ;  but  to  the  student  of  human  motive  and 
action,  the  two  affairs  are  fundamentally  similar,  and  the 
observation  of  each  throws  light  on  the  occurrence  of  the 
other.  It  seems  to  me  that  insanity  can  never  be  studied 
profitably  so  long  as  the  purview  of  the  alienist  is  limited  to 
those  cases  which  are  either  consigned  to,  or  are  fit  for,  the 
interior  of  a  lunatic  asylum.  There  is  nothing  new  under 
the  sun,  and  in  particular  nothing  wholly  novel  ever  occurs 
in  the  bodily  processes.  Morbid  action  is  not  novel  action. 
It  is  not  a  new  mode  or  way  of  working  which  has  been 
suddenly  introduced  among  the  bodily  processes,  as  a  new 
process  of  dyeing  or  printing  is  introduced   into  a  cotton 


202  SANITY    AND    INSANITY. 

factory.  Morbid  action  of  every  kind  is  nothing  but  the 
exaggeration  of  normal  action.  When  morbid  action  occurs, 
it  does  not  mean  that  an  entirely  new  element  has  been 
added  to  the  bodily  processes  ;  it  merely  means  that  some 
process  which  was  always  present,  always  active,  and  always 
took  its  share  in  the  economy  of  the  body,  has  either  failed 
to  maintain  its  due  activity,  or  has  taken  on  a  phase  •  of 
activity  in  excess.  What  is  true  of  all  other  morbid  mani- 
festations is  true  also  of  insanity.  The  disorders  of  mind 
and  of  conduct  which  constitute  insanity  are  not  evidence 
of  the  introduction  of  some  entirely  new  method  of  working 
into  the  bodily  processes  ;  they  are  evidence  merely  of  some 
exaggeration — some  defect  or  excess,  or  combination  of 
defect  and  excess — in  the  normal  working  of  the  nerve 
tissues. 

If  this  be  so,  and  surely  every  one  nowadays  will  admit 
that  it  is  so,  then  will  become  apparent  the  urgent 
necessity  of  noticing  the  nature  and  peculiarities  of  these 
departures  from  the  normal,  not  so  much  when  they  are  full- 
blown and  developed  to  excess,  as  in  their  first  beginnings, 
in  their  earliest  stages,  when  the  departure  from  the  normal 
is  slightest,  when  the  particular  processes  in  which  the 
disorder  begins  are  most  easily  identified,  and  the  nature 
and  direction  of  the  departure  most  obvious. 

Darwin  has  left  on  record  the  despair  that  he  felt,  on 
contemplating  some  phase  of  animal  life  in  all  the  marvel- 
lous elaborateness  of  its  full  development,  of  ever  being  able 
to  account  for  its  origin,  or  to  indicate  the  steps  by  which  it 
had  arrived  at  its  completion.  In  endeavouring  to  trace  the 
origin  of  the  magnificent  ocelli  on  the  train  of  the  peacock, 
"  the  first  species  of  Polyplectron  which  I  examined  "  he  says, 
"  almost  made  me  give  up  the  search."  "  Granting  what- 
ever instincts  you  please,  it  seems  at  first  quite  inconceivable 
how  they  [hive  bees]  can  make  all  the  necessary  angles  and 
planes,  or  even  perceive  when  they  are  correctly  made." 
In  the  case  of  insect-communities  he  finds,  among  many 
others,  "  one  special  difficulty  which  at  first  appeared  to  me 


THE    CAUSES   OF    INSANITY.  203 

insuperable,  and  actually  fatal  to  the  whole  theory "  of 
natural  selection.  In  all  these  cases  the  difficulties  were  at 
length  surmounted,  and  the  mode  of  origin  and  the  laws  of 
relationship  were  at  length  discovered  ;  and  by  what 
means  ?  "  Let  us  look,''  he  says,  "  to  the  great  principle  of 
gradation,  and  see  whether  Nature  does  not  reveal  to  us  her 
method  of  work."  And  in  the  principle  of  gradation  he 
finds  revealed  the  mode  in  which  these  marvellous  develop- 
ments have  been  attained.  He  finds  that  the  single  ocellus 
on  the  feather  of  the  peacock  has  an  indentation  at  the 
lower  end.  In  P.  maccalense  he  finds  an  ocellus  with 
indentations  both  above  and  below.  In  P.  hardwickn  he 
finds  two  ocelli  side  by  side  and  confluent  in  the  middle. 
In  P.  chinqm's  he  finds  two  side  by  side  and  converging, 
though  not  touching  ;  and  in  other  forms  he  finds  marks 
graduating  from  the  perfect  ocellus  to  the  ordinary  bars  and 
stripes  which  are  so  common  on  the  plumage  of  birds.  So 
amongst  bees  he  finds  a  series,  at  one  end  of  which  "  we 
have  bumble  bees  which  use  their  old  cocoons  to  hold 
honey,  sometimes  adding  to  them  short  tubes  of  wax,  and 
likewise  making  separate  and  very  irregular  rounded  cells  of 
wax.  At  the  other  end  of  the  series  we  have  the  cells  of  the 
hive  bee,  placed  in  a  double  layer  ;  each  cell,  as  is  well 
known,  is  an  hexagonal  prism,  with  the  basal  edges  of  its 
six  sides  bevelled  so  as  to  join  an  inverted  pyramid  of  three 
rhombs.  These  rhombs  have  certain  angles,  and  the  three 
which  form  the  pyramidal  base  of  a  single  cell  on  one  side  of 
the  comb  enter  into  the  composition  of  the  bases  of  three 
adjoining  cells  on  the  opposite  side."  Here  we  have  highly 
elaborate,  bizarre,  and  extraordinary  manifestations  of  life, 
accounted  for  and  explained  by  tracing  the  gradual  steps  of 
their  development  from  ordinary  forms  ;  and  similarly  we 
may  well  despair  of  being  ever  able  to  account  for  the 
elaborate,  bizarre,  and  extraordinary  manifestations  of  in- 
sanity, so  long  as  we  confine  our  attention  to  instances  of 
the  full-blown  malady.  It  is  only  when  we  trace  the  gradual 
aberration  of  mind  and  conduct  from  the  normal,  that  we 


204  SANITY    AND    INSANITY. 

shall  be  able  to  account  for  and  explain  the  more  exaggerated 
and  striking  cases  of  insanity  ;  and  attention  must  be  paid 
quite  as  much  to  the  initial  and  intermediate  stages  as  to  the 
fully  developed  malady.  Hence,  although  no  one  would 
think  of  placing  in  a  lunatic  asylum  a  person  suffering  from 
the^  delirium  of  fever,  yet  the  different  mode  of  treatment, 
the  pronounced  bodily  malady,  and  the  directly  assignable 
causation,  must  not  blind  us  to  the  substantial  identity  of 
ordinary  febrile  delirium  and  ordinary  non-febrile  delirium. 

As  if  to  emphasize  this  doctrine  and  ^clench  the  matter,  it 
occasionally  happens  that  the  delirium  of  fever  occurs  in.  an 
unusually  intense  and  exaggerated  form,  while  the  bodily 
symptoms  are  but  slightly  pronounced.  In  such  cases  the 
fever  may  be  overlooked,  and  the  prominence  of  the  disorder 
of  mind  and  conduct  may  be  such  as  to  necessitate,  or  at 
least  excuse,  the  despatch  of  the  patient  to  an  asylum  ;  and 
cases  are  occasionally  admitted  to  these  institutions  as  cases 
of  lunacy,  which  subsequently  turn  out  to  be  merely 
exagcrerations  of  febrile  delirium.  I  have  seen  cases,  of 
I        apparently  ordinary  mania,  which  turned  out  to  be  cases  of 

T\   j    typhoid  fever,  of  typhus,  small-pox,  and  scarlet  fever,  with 

' -NfJ  unusually  prominent  delirium. 

'^'  It  has  been  said,  in  introducing  the  subject  of  direct 
stresses,  that  from  their  character,  their  effect  is  so  powerful 
that  no  nervous  system,  however  stably  constituted,  is  able 
to  resist  them.  However  thoroughly  a  man's  brain  may  be 
organized,  a  blow  on  the  head  will  stun  him  if  it  be 
sufficiently  severe  ;  and  similarly,  however  stably  and  well 
his  nerve  molecules  may  be  arranged,  the  direct  action  of  a 
poison,  circulating  in  the  blood  which  bathes  them,  will 
suffice  to  upset  their  arrangement,  provided  that  the  dose  of 
the  poison  is  large  enough.  It  is  obvious,  however,  that  the 
magnitude  of  the  dose  that  is  necessary  will  depend  on  the 
amount  of  stability  of  the  structure  on  which  it  acts  ;  so  that 
here  again  we  are  brought  into  contact  with  the  law  of  the 
causation  of  insanity  as  originally  expressed.  It  is  a  function 
of  two    variables — heredity  and  stress.     The  more   of  pre- 


THE   CAUSES   OF    INSANITY.  205 

disposition  by  heredity  exists  in  a  brain,  the  weaker  the  stress 
necessary  to  derange  it  ;  and  conversely,  the  more  stable  the 
inherited  structure  of  the  brain,  the  stronger  the  influence 
that  must  be  brought  to  bear  on  it  in  order  to  produce  dis- 
arrangement. Hence  we  find,  that  the  amount  of  delirium 
produced  by  a  poison  in  the  blood,  varies  both  with  the 
character  of  the  person  and  with  the  amount  of  the  poison. 
Some  persons  can  be  made  drunk  by  a  glass  of  sherry  ;  in 
others,  half  a  'gallon  of  whiskey  is  required  to  produce  the 
same  effect.  Only  give  a  man  enough  alcohol  and  he  must 
get  drunk.  And  with  the  same  person,  the  more  drink  you 
give  him,  the  drunker  he  gets.  Different  people,  it  is  true, 
display  the  effects  of  drunkenness  in  different  ways,  but  this 
is  a  matter  concerning  the  forms  of  insanity,  and  will  be 
dealt  with  presently. 

The  last  of  the  direct  stresses  that  we  have  to  consider  is 
also  one  of  the  most  frequent,  and,  like  all  stresses  of  this 
nature,  is  one  of  considerable  potency  ;  it  is  sleeplessness. 
The  necessity  of  complete  rest  at  short  intervals  for  the 
higher  nerve  regions  is  imperative  and  absolute.  During 
wakefulness  the  drain  of  energy  from  these  regions  is 
continuous,  and  unless  they  are  allowed  the  opportunity, 
which  is  given  them  during  sleep,  of  recouping  themselves 
of  this  energy,  they  will  fail  to  act  ;  and  not  only  will  they 
fail  to  act,  but  as  the  drain  of  energy  goes  on  they  will  break 
down  and  become  disorganized.  Since  energy  is  stored  by 
the  building  up  of  atoms  into  complex  arrangements,  and 
since  energy  is  liberated  by  the  falling  of  these  atoms  into 
arrangements  of  greater  simplicity,  it  is  evident  that  a 
continuous  drain  of  energy  will  result  in  the  displacement  of 
the  atoms  to  such  an  extent  that  the  integrity  of  the 
molecule  is  invaded  and  its  structure  disorganized. 

The  conditions  to  which  sleeplessness  may  be  due  are 
various,  and  include  anything  which  prevents  the  cerebral 
molecules  from  subsiding  into  inactivity.  The  ease  with 
which  this  subsidence  takes  place  varies  naturally  in  different 
individuals,  some  being  from  childhood  bad    sleepers,    and 


206  SANITY    AND   INSANITY. 

Others  by  nature  somnolent.  Some, -when  sleep  is  obtained, 
are  habitually  light,  and  others  habitually  heavy  sleepers. 
Of  the  conditions  which  favour  or  retard  the  natural 
tendency  of  the  nerve  molecules  to  repose,  some  are  external 
to  the  organism  and  others  are  within  it. 

The  external  conditions  which  favour  sleep  are  those 
which  tend  to  reduce  the  total  of  impressions  made  upon  the 
organism.  All  such  impressions  set  up  nerve  currents,  which 
break  in  waves  upon  the  higher  nerve  regions,  and  tend  to 
keep  them  in  a  state  of  activity.  Hence  sleep  naturally 
takes  place  at  that  period  of  the  day  at  which  such  im- 
pressions are  least  numerous  and  forcible  ;  and  hence,  when 
it  is  desired  to  favour  the  access  of  sleep,  these  impressions 
are  as  far  as  possible  minimized.  The  blinds  are  drawn  and 
the  shutters  shut,  to  exclude  the  influence  of  light  waves  on 
the  eye.  Silence  is  secured  as  far  as  is  practicable.  The 
body  is  so  disposed  on  a  soft  couch  that  a  minimum  of  acute 
feelings  of  contact  are  aroused.  In  a  high  temperature 
nervous  activity  is  more  readily  evoked  than  in  a  low 
temperature,  and  hence  we  fall  asleep  more  readily  when  we 
are  cool  than  when  we  are  hot. 

The  internal  conditions  which  favour  sleep  are,  generally, 
those  that  tend  to  produce  quiescence  of  nerve  molecules  ; 
and  vice  versa.  Fatigue,  by  exhausting  the  molecules  of 
their  store  of  energy,  renders,  as  already  explained,  their 
response  to  stimuli  less  active,  less  energetic,  less  ready ;  and 
hence  conduces  towards  sleep.  Activity  of  the  nerve 
molecules  requires  a  copious  supply  of  blood  to  the  brain, 
and  vice  versa.  Hence  after  meals,  when  a  large  draught  of 
blood  is  switched  off  to  the  abdomen  to  serve  the  purposes 
of  digestion,  drowsiness  is  the  normal  condition.  Hence  we 
see  that  the  rule  among  the  lower  animals  is' — after  food, 
sleep.  Hence  we  find  the  custom  among  civilized  men  of 
administering  a  dose  of  strong  coffee  after  dinner  to  counter- 
act the  naturally  soporose  effect  of  the  meal.  Hence  we  find 
that,  with  children  especially,  whose  digestion  is  rapid,  the 
best  soporific  is  a  hearty  supper. 


thp:  causes  of  insanity.  207 

As  with  nerve  currents  originated  by  external  impressions, 
so  with  currents  started  by  internal  processes,  an  undue 
intensity  will  keep  the  molecules  of  the  higher  nerve  regions 
in  activity,  and  so  prevent  sleep.  Hence  painful  bodily 
processes  are  efficient  sleep  preventers  ;  and  hence  any 
process  which,  without  causing  pain,  is  of  undue  activity, 
will  prevent  sleep.  The  mental  attitude  of  attention 
corresponds,  upon  the  bodily  side,  with  an  exaggerated 
activity  of  the  higher  nerve  regions,  and  hence  sleep  and 
attention  are  mutually  exclusive.  If  the  attention  is  actively 
aroused  and  maintained,  sleep  becomes  impossible  ;  and 
hence  the  sleeplessness  of  anxiety,  for  anxiety  is  but  a 
strained  attention  upon  an  impending  disaster. 

Lastly,  the  nervous  system  is,  as  we  have  seen,  literally  a 
creature  of  habit — depends  for  its  existence  and  organization 
upon  habit,  and  therefore  we  shall  not  be  surprised  to  find 
in  any  of  its  functions  that  habit  assumes  a  dominant 
influence.  In  the  occurrence  of  sleep  the  influence  of  habit 
is  very  powerful.  At  the  time  at  which  we  are  in  the  habit 
of  going  to  sleep,  we  become  drowsy.  At  the  time  at  which 
we  are  in  the  habit  of  waking,  we  wake.  The  night  watch- 
man, who  has  formed  the  habit  of  sleeping  by  day,  becomes 
naturally  drowsy  in  the  morning  and  wakeful  at  night. 
The  sailor  who  has  habituated  himself  to  intervals  of  four 
hours'  rest  with  four  hours'  activity,  finds  that  his  periods  of 
wakefulness  and  drowsiness  come  to  correspond  naturally 
with  his  hours  of  duty  and  of  rest.  A  slothful  man  acquires 
little  by  little  the  habit  of  prolonging  his  hours  of  sleep  far 
beyond  the  average,  and  beyond  his  requirements  ;  and 
similarly  it  is  quite  possible,  and  is  not  very  infrequent,  for  a 
person  whose  nerve  molecules  are  naturally  indisposed  to 
quiescence,  to  contract  a  vicious  habit  of  wakefulness  that  is 
often  extremely  difficult  to  overcome. 

Whatever  its  cause,  persistent  sleeplessness  is  a  condition 
which  is  highly  favourable  to  the  development  of  insanity, 
and  in  most  acute  attacks  of  insanity  sleeplessness  is  a 
prominent  feature.     Doubtless  the  insomnia  of  incipient  or 


208  SANITY   AND   INSANITY. 

early  insanity  is  to  some  extent  a  symptom  and  a  result  of 
the  morbid  process  in  the  brain,  which  underlies  the 
insanity  ;  but  none  the  less  does  it  assist  and  reinforce  the 
process  to  which  it  is  primarily  due.  As  a  matter  of  clinical 
experience,  we  find  that  in  acute  outbreaks  of  insanity  that 
are  accompanied  by  sleeplessness,  the  induction  of  sleep  is 
usually  followed  by  improvement  in  the  insanity  ;  while 
cases  in  which  insanity  has  become  developed  without  the 
accompaniment  of  insomnia,  are  as  a  rule  less  hopeful. 


CHAPTER  VIII. 

THE  CAUSES  OF  INSANITY  [Continued). 

Indirect  Stress  of  Internal  Origin. 

Indirect  stresses  are  of  two  kinds,  as  has  been  said  :  those 
in  which  the  agent  is  some  commotion  in  the  organism  itself, 
and  those  in  which  it  is  a  commotion  in  the  environment. 
In  either  case  the  stress  is  appUed,  not  directly  to  the 
highest  nerve  regions,  but  indirectly,  through  the  medium 
of  the  afferent  or  in-going  nerves  ;  to  the  visceral  or  systemic 
nerves  in  the  first  case,  and  to  the  nerves  of  special  sense 
in  the  second.  The  stress  applied  at  the  peripheral  end  of 
the  nerve  is  in  either  case  communicated,  through  the  nerve 
and  the  intermediate  centres,  to  the  highest  nerve  regions, 
and  there  produces  its  effect. 

Of  the  first  kind  of  indirect  stresses — those  of  internal 
origin — there  are,  as  already  stated,  two  orders,  one  arising 
from  general  commotions  pervading  the  whole  organism, 
and  the  other  from  local  commotions  directly  affecting  parts 
only  of  the  organism.  The  general  commotions  are  those 
occasions  of  widespread  and  virtually  universal  turmoil, 
which  accompany  the  great  and  fundamental  changes  of 
constitution  that  occur  from  time  to  time  in  the  natural 
progress  of  life.  Such  is  the  commotion — the  internal 
revolution — that  takes  place  at  puberty.  Such  are  the 
changes  of  the  climacteric,  of  marriage,  pregnancy,  and  child- 
birth. Other  general  internal  commotions  are  those  por- 
duced  by,  and  accompanying,  fevers  and  other  general  or 
"  constitutional  "  bodily  maladies. 

15. 


2IO  SANITY   AND    INSANITY. 

Of  these    internal    commotions,    the   first   in    order,  and 
perhaps  the  most   important,  is  that  of  puberty.     It  is  at 
this  stage  of  hfe  that  the  process  of  development  is  subjected 
to  its  first  severe  strain.     The  organism,  which  has  hitherto 
been   travelling  at   a  rapid  pace  along  a  smooth  and  even 
path  of  development,  almost  suddenly  comes  upon  a  piece  of 
difficult  country,  and,  in  travelling  rapidly  over  the  rough 
ground,  it  is  liable  to    upset.     How  great  is    the    internal 
commotion  that    accompanies  the  evolution  of   the  sexual 
characters,  and  the  attainment  of  the  powers  of  reproduction, 
may  be  to  some  extent  inferred  from  an  enumeration  of  the 
changes  that  then  take  place.     The  individual  diverges  from 
the  neutral  condition  of  childhood,  and  takes  on  the  dis- 
tinctive  characters    of    his    or    her    sex.     In    the    male,    in 
addition  to  the    rapid    development    of   the  sexual  organs, 
the  frame  fills  out,  the  bones  become  thicker  and  more  solid, 
the  general  outline  squarer,  more  rugged,  and  more  manly. 
The   voice    changes,    owing    to    the    development    of    the 
structures  of  the   throat,  and  the  beard  buds  and  sprouts. 
These  changes  in  the    body  at  large  are   mirrored  in  the 
higher    nerve    regions.     In    their    development  also  a  new 
start  is  made.     New  desires,  new    passions,   new  emotions 
come  into  being  ;  not  only  the  bodily  organization,  but  the 
mental  organization  also,  undergoes  a  revolution.     This  new 
development    is    made    with    comparative     rapidity.     The 
emotions  and  desires  of  freedom,  of  acquisition  of  property, 
•of  power,  of  self-reliance,  dignity,  sympathy,  and  so  forth, 
are  of  slow  growth,  and   develop  with  the  development  of 
the  organism  at  large.     But  the  emotions  and  desires  of  love 
are,  with   the  concomitant   bodily  changes,   developed  at  a 
certain  time  of  life  with  great  rapidity.     Now,  all  rapid  de- 
velopment is,  as  we  have  seen,  more  or  less  unstable  develop- 
ment ;  and  the  period  during  which  this  rapid  development  is 
taking  place  is  a  period  of  more  than  usual  instability.     We 
may   compare   it  to    the   condition   of   a   country   which   is 
undergoing    an    internal    revolution.     At   such   a    time    an 
invasion  would  have  far  more  chance  of  success  than  when  a 


THE    CAUSES    OK    INSANITY.  211 

iirm  and  stable  power  was  settled  in  the  government  )  and 
when  the  human  organism  is  undergoing  the  revolution  of 
puberty,  ordinary  stresses,  which  at  other  times  would  be 
innocuous,  are  apt  to  have  disastrous  effects.  If  the  general 
political  condition  of  the  country  be  unstable,  then  the  effect 
of  a  revolution  may  be  to  produce  prolonged  or  permanent 
anarchy,  as  we  see  in  some  of  the  South  American  republics  ; 
and  if  the  general  constitution  of  the  individual  be  primarily 
unstable,  the  effect  of  the  revolution  of  puberty  may  be  to 
produce  insanity  of  more  or  less  permanent  character. 

If  such  be  the  effect  of  the  access  of  puberty  in  the  male, 
in  whom  the  revolution  is  comparatively  slight  and  com- 
paratively prolonged,  we  may  be  sure  that  in  the  female,  in 
whom  the  change  is  far  more  rapid  in  progress  and  of  a  far 
more  momentous  character,  the  commotion  will  be  more 
tumultuous  and  attended  with  greater  disturbance.  Whereas 
in  man  the  attainment  of  maturity  is  gradual,  and  the 
changes  of  puberty  are  spread  over  many  years,  in  woman 
the  evolution  takes  place  very  rapidly,  and  the  individual 
*'  passes  at  a  bound,  as  it  were,  from  childhood  to  woman- 
hood," the  change  in  her  between  the  ages  of  fourteen  and 
eighteen  being  as  complete  as  in  man  between  fifteen  and 
iive-and-tw^enty.  In  woman,  too,  the  changes  are  greater. 
The  organs  which  subserve  the  function  of  reproduction, 
and  which  pass  at  puberty  from  a  rudimentary  and  dormant 
condition  to  full  development  and  activity,  are  more  nume- 
rous, and  occupy  thereafter  a  more  conspicuous  and  more 
important  position  and  function  in  her  economy  than  in  the 
case  of  man.  The  mental  changes  that  accompany  puberty 
in  the  female  are  also  greater  and  more  momentous  than  in 
the  male.  In  the  one  the  character  develops  ;  in  the  other 
it  is  revolutionized.  The  access  of  activity,  both  general 
and  special,  that  accrues  to  both  sexes  at  this  period  of  life, 
finds  means  of  outlet  and  satisfaction  in  very  different 
direction  and  degree  in  each.  In  man  at  this  period  not 
only  does  the  special  activity  find  ready  outlet,  since  to  him 
belongs  by  ancient  and  prescriptive  custom  the  initiation  of 


212  SANITY   AND    INSANITY. 

the  overtures  of  love  ;  but  at  the  same  period  of  life  he  is 
usually  provided  with  abundant  outlets  for  the  general 
activities  of  his  nature,  which  then  receive  so  marked  an 
accession  to  their  vigour.  It  is  at  this  time  that  he  relin- 
quishes the  preparatory  process  of  education,  and  enters  on 
the  more  serious  and  important  business  of  life.  It  is  at 
this  time  that  he  joins  a  profession,  or  a  house  of  business, 
or  enters  on  that  walk  of  life  from  which  in  future  he  is  to 
gain  his  livelihood.  He  emerges  from  his  larval  condition 
and  takes  on  the  full  functions  of  manhood.  He  begins  to 
earn  his  own  living  ;  he  becomes  a  member  of  society,  a 
citizen,  a  social  unit.  Whatever  activities  are  left  unsatisfied 
and  unabsorbed  when  his  work  is  done,  and  the  serious  and 
necessary  business  of  earning  his  livelihood  is  completed  for 
the  day,  find  easy  and  abundant  outlet  in  a  hundred 
different  fields.  He  can  have  assigned  to  him  military  or 
quasi-military  duties  ;  he  can  undertake  athletic  exercises. 
Volunteering  or  cycling,  or  rowing  or  cricket,  becomes,  in  a 
secondary  degree,  the  business  of  his  life.  He  can  enter 
freely  into  clubs  and  societies  of  various  kinds,  can  take  up 
a  special  study  or  pursuit,  a  science  or  an  art,  and  find  in 
such  pursuits  channels  of  escape  for  the  activities  which  are 
so  vigorously  and  copiously  generated  within  him. 

With  women,  matters  are  very  different.  The  special 
activity  that  originates  at  puberty,  and  craves  for  expression, 
cannot  in  them  find  spontaneous  outlet.  They  must  wait 
until  occasion  arises.  They  may  indeed,  and  do,  give  their 
love  unsought,  but  they  may  not  give  it  expression  until  it 
has  been  required  of  them  ;  and  the  activity  which  can  find 
no  expression  is  unsatisfied.  Unlike  their  brothers,  they 
have  not  those  copious  and  multitudinous  channels  of  outlet 
for  their  general  activities,  which,  if  freely  utilized,  draft  off 
such  large  quantities  of  activity,  lower  the  nervous  tension 
generally,  and  so  not  only  diminish  the  sexual  craving,  but 
provide  a  safety  valve  for  the  escape  of  the  nervous  energy, 
and  obviate  the  likelihood  of  a  dangerous  accumulation. 
For   all   these  reasons — the  greater  magnitude  and  greater 


THE    CAUSES   OF    INSANITY.  213 

rapidity  of  the  change,  and  the  much  smaller  outlet  for  the 
increased  activities — the  access  of  puberty  in  woman  is  a 
period  of  far  g^reater  strain,  of  more  tumultuous  revolution, 
of  more  enhanced  liability  to  disorder,  than  in  man. 

That  the  gravamen  of  the  liability  to  disorder  will  lie  with 
special  intensity  on  the  higher  regions  of  the  nervous  system, 
is  apparent  from  several  considerations.  The  alteration  in 
the  coensesthesis,  due  to  the  virtual  addition  of  several  new 
and  important  viscera  to  the  organism,  is  itself  a  source  of,  and 
a  provocation  to,  disorder  ;  for  the  nervous  system  has, 
during  the  previous  years  of  life,  become  accustomed  to  act 
under  the  influence  of  a  certain  set  of  incoming  currents. 
Any  large  and  sudden  addition  to  these  incoming  currents 
must  of  necessity  produce  disturbance,  and  until  the  nervous 
system  becomes  equilibrated  to  the  new  conditions  acting 
upon  it,  the  disturbance  will  be  apt  to  increase  into  disorder. 
At  the  same  time  that  these  new  forces  are  acting  on  it 
through  the  nerves,  the  brain  is  itself  undergoing  rapid  and 
widespread  change.  New  emotions,  new  passions,  new 
cravings,  a  whole  set  of  new  feelings,  are  being  added  to  the 
mental  constitution  ;  and  this  means,  as  we  already  know, 
that  new  developments  must  be  rapidly  taking  place  in  the 
higher  regions  of  the  brain  ;  for  no  change  can  take  place  in 
the  shadow,  mind,  without  a  corresponding  change  having 
taken  place  in  the  substance,  brain.  So  that  these  alterations 
in  the  ccenaesthesis,  these  new  and  disturbing  forces,  are 
acting  on  a  material  which  is  itself  undergoing  extensive 
and  rapid  changes,  and  is  therefore,  as  before  shown,  more 
easily  deranged.  The  access  of  puberty  is,  therefore,  in  all 
women  a  time  of  danger,  and  so  powerful  are  the  disturbing 
elements  that  at  that  time  act  on  the  constitution  of  the 
higher  nerve  regions,  that  few  women  pass  through  this 
period  of  their  development  without  manifesting  signs  of 
disorder  of  those  regions.  Thus,  at  this  period,  more  or 
less  decided  manifestations  of  hysteria  are  the  rule.  The 
girls  who  fail  to  exhibit  some  hysterical  symptom  at  puberty 
are  few  indeed.     In  hysteria  there  is  disorder  of  mind,  that 


214  SANITY   AND   INSANITY. 

is,  of  thought,  or  feeUng,  or  both  ;  and  there  is  disorder  of 
conduct.  Hence  hysteria  is  closely  allied  to  insanity,  is  in 
fact  a  slight  or  temporary  manifestation  of  the  phenomena 
which,  if  more  decided  or  more  prolonged,  become  un- 
questionable ordinary  insanity.  At  the  same  time  hysteria 
is  not,  like  anaemia,  and  like  drunkenness  in  all  its  manifes- 
tations, merely  a  temporary  insanity  due  to  a  temporary 
cause.  The  nervous  disturbance  in  hysteria  may,  it  is  true^ 
affect  the  higher  centres  only,  and  then,  indeed,  are  presented 
the  phenomena  of  a  slight  or  temporary  insanity.  In  such 
cases  there  is  marked  disorder  of  conduct,  there  is  undue 
emotional  instability,  that  is  to  say,  the  signs  of  emotion — 
laughing,  crying,  &c. — are  exhibited  in  marked  and  emphatic 
fashion  on  occasions  which  should  not  normally  evoke  much 
emotion.  The  manifestations  of  emotion  may  be  so  extreme 
as  to  be  manifestly  out  of  proportion,  not  only  to  the 
occasion  in  which  they  occur,  but  to  any  occasion.  Laughter 
may  continue  till  the  laugher  is  completely  exhausted,  or 
even  may  merge  into  general  convulsions.  Activity  is 
usually  defective.  The  patient  is  sluggish,  slow,  languid, 
and  anergic  ;  sometimes  persistently,  sometimes  with  in- 
tervals of  eager,  feverish,  and  shortlived  activity.  Often  the 
activity  is  so  defective  that  the  patient  takes  to  her  bed  and 
remains  there,  without  the  justification  of  any  bodily  ailments 
In  addition  to  mere  excess  or  defect  of  activity,  or  of  alterna- 
tion of  defect  and  excess,  conduct  may,  and  usually  does,  in 
high-level  hysteria,  exhibit  other  disorders  of  more  permanent 
and  more  complex  character.  The  disorder  may  be  slight ^ 
may  merely  consist  in  little  eccentricities,  in  alterations  of 
dress  a  little  too  pronounced,  in  too  marked  a  preference  for 
little  secrets  and  mysteries,  or  in  a  newly-developed  fancy 
for  teasing  and  annoying  other  people.  Occasionally,  how- 
ever, these  disorders  of  conduct  exhibit  themselves  in  much 
graver  form.  The  eccentricities  may  develop  into  conduct 
so  bizarre  as  to  be  manifestly  insane.  The  alterations  of 
dress  may  take  the  form  of  wearing  crowns  and  tawdry 
ornaments,  and   be  associated   with   delusions  of  grandeur. 


THE    CAUSES   OK    INSANITY.  21 S 

The  inclination  to  possess  secrets  and    to  make  mysteries 
may  lead   to  the  perpetration   of  impostures  of   the   most 
extraordinary  kind.     One   girl   will  go  for   weeks   without 
bodily  sustenance,   another  will   go   for  weeks  without    an 
action  of  the  bowels,  another  will  exhibit  stigmata — bleeding 
points  on  the  hands,  feet,  and  side,  in  imitation  of  the  five 
wounds  of  Christ.     Others  will  simulate  pregnancy  ;  others 
will  pretend  to  be  blind,  deaf,  dumb,  or  to  be  able  to  speak 
only   in    a   whisper.     An    hysterical  girl   will  have  "  more 
diseases  than  two-and-fifty  horses."    The  most  serious  mani- 
festation of  disordered  conduct  in  hysteria  is,  however,  the 
development  of  the  appetite  for  teasing — for  giving  pain  and 
annoyance  to  others.     When  this  is  developed  in  excess,  it 
results    in  nothing   short    of   murder,  and   very   numerous 
cases  have  occurred  of  apparently  motiveless  murders  com- 
mitted   by  young    girls    about   the   age  of   puberty.      The 
victims  are  usually  young  children,  these  being  obviously 
the  only  class  of  persons  whose  death  can  be  compassed  by 
direct  violence  by  young  girls  ;  and  from  the  time  of  the 
celebrated  Road  murder  by  Constance  Kent,  cases  have  from 
time  to  time  been  reported  of  the  murder  of  young  children 
without    discernible   motive,    and    in    a    very   cold-blooded 
manner.     When  such  a  murder  is  committed,  and  is  com- 
mitted in   secresy,  and  with  precautions   against  discovery 
which  are  absent  in  ordinary  homicide  by  the  insane,  it  is 
invariably  found  that  the  murderer  is  a  young  girl. 

The  circumstances  that  commonly  differentiate  hysteria 
from  insanity  are  that,  while  in  hysteria  conduct  is  disordered, 
the  disorder  of  intelligence  which  enters  so  largely  into  our 
concept  of  insanity  is  usually  inconspicuous  ;  and  secondly, 
that  there  often  exists  in  hysteria  some  bodily  malady  or 
quasi-malady,  whose  prominence  obscures  and  eclipses  the 
manifestations  of  disorder  of  mind  and  conduct.  The  factor 
that  most  clearly  and  decisively  differentiates  the  two  will 
be  subsequently  considered. 

Although  in  hysteria  disorder  of  mind  is  often  incon- 
spicuous, yet  it   is   always   present.      It   is    notorious   how 


21 6  SANITY   AND   INSANITY. 

tumultuous  and  stormy  are  the  manifestations  of  emotion  ; 
the  exaggerated  laughter,  ending  in  exhaustion,  or  it  may- 
be in  actual  convulsion  ;  the  excessive  accessions  of  weeping, 
disproportionate  to  the  occasions  on  which  they  occur  ;  the 
gusts  of  anger  ;  the  fits  of  sulks  ;  the  frequent  attitude  of 
suspicion.  All  these  manifestations,  undue  and  excessive  as 
they  are,  indicate  amounts  or  phases  of  feeling  that  are  not 
adjusted  to  the  circumstances  in  which  they  occur, — that  are 
disordered. 

The  chief  disorders  of  feeling  that  occur  in  hysteria  do 
not,  however,  find  a  place  under  any  of  the  foregoing 
headings.  They  are  of  a  more  subtle  character,  and  one 
almost  peculiar,  if  not  to  the  malady,  at  any  rate  to  the  time 
of  life  and  the  class  of  persons  in  whom  the  malady  is  most 
prone  to  occur.  We  have  seen  that  the  main  characteristic 
ot  the  bodily  changes  that  occur  at  puberty  is  the  addition 
of  new  viscera  and  new  functions  ;  and  the  characteristic  of 
the  change  in  the  working  of  the  nervous  system  is  a  great 
and  rapid  addition  to  the  contribution  made  to  the  general 
volume  of  the  nervous  currents  by  that  portion  which  comes 
from  the  viscera.  And  the  reception  of  the  nerve  currents 
from  the  viscera — the  representation  of  the  body  itself  in  the 
higher  nerve  regions — is  the  foundation  or  physical  side  of 
the  coensesthesis : — the  obscure,  underlying,  but  fundamental 
portion  of  consciousness  which  constitutes  the  "  ego,"  the 
"  conscious  personality,"  the  consciousness  of  self,  as  distin- 
guished from  the  consciousness  of  surroundings.  In  young 
children  this  self-consciousness  exists  in  rudimentary  form 
only.  Almost  the  whole  of  their  consciousness  is  concerned 
with  things  around  them.  With  the  workings  of  their  own 
mmds,  and  the  effects  of  their  surroundings  on  themselves, 
they  are  but  little  concerned.  So  completely  externalized 
are  their  thoughts  that  even  in  speaking  of  themselves  they 
will  speak  in  the  third  person.  A  child  comes  to  his  mother 
and  says,  not  "  I  have  hurt  myself,"  but  "  Baby  has  hurt 
himself."  He  will  say,  not  "  Give  it  to  me,"  but  ''  Give  it 
to  Jacky."     And  in   using  these   expressions    he    indicates 


THE    CAUSES    OF    INSANITY.  217 

that  the    distinction    between    the   conscious    self   and    the 
world   around   is   not  yet  thoroughly  appreciated.     As  the 
body  develops,  and   as  mind   develops  with  the  body,  the 
^'  ego  "  comes  more  into  prominence,  and  soon  attains  com- 
plete differentiation  from  the  world  at  large  ;  and  when,  at 
puberty,    a    large    and    sudden    addition    is    made    to  the 
coensesthesis,  the  consciousness  of  self  swells  and    increases 
to  dimensions  that  easily,  and  in  many  cases,  become  exces- 
sive.    The  consciousness  of  the  surroundings,  of  the  world 
they  live  in,  and  of  the  scenes  and  events  that  are  going  on 
in  it,  is  no  longer  the  predominant  and  almost  sole  con- 
stituent in  consciousness.     In  concomitance  with  the  increase 
in   volume  and  alteration  in  the  constitution  of  the  nerve 
currents  poured    in  from    the    interior   of   the   body,  ^  arise 
elements  in  the  constitution  of  consciousness  that  are  new, 
and  that  for  a  while  are  dominant.     No  longer  concerned 
entirely  with  circumstances  and  events  in  the  outside  world, 
consciousness    becomes    largely    engaged    with    these    new 
constituents,  w^hich  have  reference  to  what  is  passing  within 
the  organism.     New  feelings,   feehngs   of   change,   strange, 
unaccustomed  sensations,  arise  and  prevail.     The  new  nerve 
currents  to   which  this   extension   of  consciousness   is   due, 
have,    in    marked    degree,    the   characters    of    the    visceral 
currents  to  which  attention  has  already  been  drawn  ;  that  is 
to    say,  they  are  voluminous  ;  they  are   continuous  ;    their 
variations  are  not  sudden  cessations  and  recommencements, 
but  are  in  weaves  of  slow  rise,  progress,  and  decline.     More- 
over, voluminous  and  powerful  as  they  are,  they  are  diffused 
and   widespread.      Their    limitations    in    space,    like    their 
limitations  in  time,  are  vague,  wanting  in   definiteness  and 
precision.     In  all  these  respects  the  feehngs  which  are  their 
conscious   accompaniments    resemble    the    nerve    currents. 
The  new  elements,  which  at  puberty  become  added  to  the 
general  consciousness  ;  the  new  feelings,  yearnings,  desires, 
cravings  ;  are,  like  the  new  nerve  currents,  powerful,  volumi- 
nous, pervading,   continuous  ;    and,   Hke   them,   are  vague, 
formless,  indefinite.     They    do    not    indicate    their   origin  ; 


2l8  SANITY    AND    INSANITY. 

they  do  not  proclaim  their  nature  ;  the  organism,  disturbed 
and  restless  under  this  strange  addition  to  its  forces,  is- 
puzzled  as  to  the  direction  in  which  the  new  activities  should 
find  their  outlet.  At  this  time  "  strange  thoughts  that  we 
do  not  understand  are  stirring  in  our  hearts.  Voices  are 
calling  us  to  some  great  effort,  to  some  mighty  work.  But 
we  do  not  comprehend  their  meaning  yet,  and  the  hidden 
echoes  within  us  that  would  reply,  are  struggling,  inarticulate 
and  dumb.''  Then  comes  some  association,  some  contact,  with 
a  more  or  less  appropriate  individual  of  the  other  sex.  At 
once  the  pent-up  current  of  emotion  bursts  its  bounds.  As 
some  liquid,  filled  to  saturation  with  a  dissolved  salt,  remains 
yet  liquid  and  formless,  with  every  particle  crammed  with 
solid  matter  in  solution,  and  so  remains  indefinitely,  yearning 
and  craving,  as  it  were,  to  yield  up  the  new  matter  of  which 
it  is  full,  and  yet  failing  for  want  of  occasion  and  incitement 
to  do  so  ;  so  the  adolescent  boy  or  girl  remains  with  his  or 
her  nature  bursting  with  emotion,  which  cannot,  in  the 
absence  of  occasion  and  of  an  object,  find  expression.  Now 
if  we  drop  into  the  solution  a  crystal  of  the  salt,  immediately 
the  liquid  yields  up  its  dissolved  contents.  At  once  the  salt 
separates  out  of  solution,  and  clusters  about,  and  coheres  to^ 
the  foreign  body,  in  a  copious  deposit  of  regular  geometrical 
crystals.  The  formless  fluctuating  liquid  is  transformed  into 
a  fixed  solid  of  definite  shape  and  firm  consistence.  So  if 
we  bring  the  boy  or  girl,  replete  with  formless  emotion,  into 
contact  with  an  appropriate  individual  of  the  other  sex^ 
immediately  the  vague  indefinite  yearnings  settle  down  upon^ 
and  cluster  about,  this  provocative  agent,  in  the  definite 
shape  of  a  more  or  less  firmly  cohesive  affection.  It  has 
been  said,  and  truly  said,  that  falling  in  love  is  a  revelation. 
It  is  so ;  for  at  once  the  meaning  and  significance  of  the  new 
cravings  and  yearnings  becomes  apparent.  They  were  the 
expression  in  consciousness  of  the  new  powers  that  had 
become  added  to  the  organism  ;  and  till  the  nature  of  these 
new  powers  was  known,  the  meaning  of  the  new  elements  in 
consciousness  remained  obscure. 


THE    CAUSES   OF    INSANITY.  219' 

It  has  been  said  that  the  occasion  of  this  crystalHzation  of 
the  saturated  consciousness  is  the  contact  with  an  appropriate 
individual,  and  to  this  the  rejoinder  will  be  that  the  indi- 
vidual is  often  not  appropriate  ;  and  this  is  true  ;  but  the 
main  statement  holds  good  all  the  same.     It  is  found  that 
the  readiest  way  to  make  a  saturated  solution   deposit  in 
crystals,  is  to  drop  into  it  a  crystal  of  the  same  salt  ;  but  if 
no  such  crystal  be  handy,  one  of  some  other  salt  will  do  ; 
and  if  no  crystal  be  obtainable,  then  any  rough  substance  or 
any  angular  solid  will  suffice  to  precipitate  the  crystalline 
deposit.     The  facts  are,   that  there  is  the   salt  craving  to 
escape  from  the  solution,  and  in  default  of  a  cognate,  similar,, 
and  appropriate  substance  to  adhere  to,  it  will  deposit  itself 
on  anything  that  gives  it  a  plausible  excuse  to  do  so  ;  and 
similarly  in  the  adolescent,  there  is  a  body  of  emotion  craving 
to  escape,  and  in  default  of  sufficient  opportunity  of  pouring 
itself  out  upon  an  appropriate  object,  a  most  inappropriate 
one  will  often  be  chosen.     It  may  appear  that  when  oppor- 
tunities are  equal  the  choice  will  not  always  fall  on  the  most 
appropriate  ;  but  then  it  must  be  remembered  that  we  are 
dealing  with  animate  and  imaginative  beings,  and  that  the 
being  with  whom  a  person  falls  in  love  exists  only  in  the 
imagination  of  the  lover.     The  lover  falls  in  love,  not  with 
his    adored    object    as    she    exists,  but  with   the    imaginary^ 
attributes  with  which  he  invests  her.     The  lady  who  told 
her  lover  that  he  was  in  love  with  certain  attributes  was  so 
far  correct,  but  her  statement  w^as  not  complete,  insomuch 
that  she  omitted  to  state  that  the  attributes  were  for  the 
most  part  imaginary.     The  lover's  answer,  it  will  be  remem- 
bered, was  "  Damn  your  attributes,  madam,  I  know  nothing 
of  your  attributes  ;  "  and  in  this  the  poor  man  was  doubtless,, 
in  his  own  belief,  correct. 

It  may  happen,  however,  that  no  object,  which  even  the 
wild  and  rampant  imagination  of  the  lover  can  invest  with 
sufficiently  attractive  attributes,  presents  itself  to  the  replete 
emotional  condition  of  the  adolescent  ;  and  when  this  is  the 
case,  we  have  an  analogy  to  the  saturated  solution  to  which 


220  SANITY   AND   INSANITY. 

no  point  for  precipitation  is  offered.  In  the  latter  case, 
what  happens  is  this  :  that  for  a  longer  or  shorter  time  no 
precipitation  occurs,  but  at  last  a  slow  and  diffused 
crystallization  takes  place  on  the  walls  of  the  containing 
vessel.  Upon  the  periphery,  the  outskirts  of  its  environ- 
ment, the  contained  matter  is  deposited  in  diffused  form, 
but  never  with  the  rapidity  nor  the  copiousness  with  which 
it  is  thrown  down  on  an  appropriate  object.  In  the  human 
being  to  whom  no  direct  and  single  outlet  is  given  for  the 
escape  of  the  emotions  of  puberty,  there  occurs  for  a  time 
no  such  escape  at  all.  Then,  after  a  time  of  suffering,  the 
pent-up  emotion  tardily  leaks  away  in  less  concentrated 
intensity  and  in  more  numerous  directions,  and  seeks 
usually  the  most  remote  and  least  definite  occasions  for 
display.  The  vague,  voluminous,  and  powerful  feelings 
which,  if  afforded  means  to  do  so,  settle  down  and  con- 
centrate on  a  single  object,  in  affection,  find  their  expres- 
sion, if  this  object  be  wanting,  in  less  direct  ways  and 
more  diffused  form.  They  take  the  shape  of  religious 
€motion,  and  expression  for  them  is  found  in  observance  of 
•ceremonial  and  in  devotion  to  a  ritual. 

To  understand  this  curious  connection  between  sexual 
and  religious  emotion,  a  connection  which  has  long  been 
recognized,  but  never  accounted  for,  it  is  necessary  to  con- 
sider the  fundamental  nature  of  both.  As  will  be  shown 
more  fully  in  the  next  chapter,  the  fundamental  quality  of 
the  sexual  emotion  is  the  willingness,  nay,  more,  the  desire, 
the  craving,  to  sacrifice  self.  The  production  of  offspring 
can  only  be  effected  by  a  sacrifice  on  the  part  of  the  parent  ; 
a  sacrifice  of  corporeal  substance  ;  a  sacrifice  of  part  of  the 
life ;  a  sacrifice  of  part  of  the  means  of  living.  The  sexual 
emotion  includes,  as  an  integral,  fundamental,  and  pre- 
ponderating element  in  its  constitution,  the  desire  for  self- 
sacrifice. 

The  same  element  is  an  important  constituent  of  religious 
emotion,  and  lies  at  the  root  of  all  religious  observance. 
The    propitiation    of  a  Deity  is,  in  all   religions,  made  by 


THE   CAUSES   OF    INSANITY.  221 

sacrifice  of  one  kind  or  another.  In  the  primitive  reUgion 
of  savage  races  the  sacrifice  is  of  food,  of  weapons,  or 
clothing.  In  the  higher  reHgions  of  civiHzed  men  the 
sacrifice  is  of  land,  or  money,  or  time,  or  work.  The  peer 
who  contributes  a  plot  of  land  as  a  site  for  a  church  is 
stirred  by  the  same  motive  as  the  shepherd  who  offers  a 
yoke  of  oxen  as  a  burnt-offering.  The  Nazarite  who,  under 
the  obligation  of  a  vow,  suffers  the  inconvenience  of  an 
unshorn  head,  is  precisely  comparable  with  the  monk  who, 
under  a  similar  obligation,  suffers  the  inconvenience  of  a 
shorn  one.  In  every  case,  religious  observance  means 
sacrifice  of  some  kind,  and  the  more  severe,  the  more 
complete,  the  more  absorbing  the  sacrifice,  the  more  com- 
plete is  the  propitiation  considered,  the  more  satisfactory 
the  religious  observance. 

In  this  common  ground  of  self-sacrifice  both  the  religious 
and  the  sexual  emotions  have  their  origin  ;  and  in  their 
further  development  they  maintain  a  close  resemblance  in 
their  voluminous  nature,  and,  previous  to  the  crystallization 
of  which  we  have  spoken,  in  the  vagueness  of  their 
characterization.  The  community  of  their  origin  and  the 
similarity  of  their  nature  allow  easily  of  the  transformation 
of  the  one  emotion  into  the  other,  and  hence  the  self-denial 
and  self-abnegation  that  would  have  been  joyously  and 
proudly  incurred  in  the  service  of  a  lover,  are  incurred  with 
equal  or  greater  fervour,  though  in  other  forms,  in  the 
service  of  a  church  which  stands  vicariously  in  the  lover's 
place.  That  emotion  which  fails  to  find  a  point  of  con- 
centration and  deposit  in  a  single  individual,  diffuses  itself 
over  a  wide  area,  and  is  expressed  in  acts  of  benevolence 
and  philanthropy  ;  but  in  such  acts  the  element  of  self- 
sacrifice  must  enter,  or  the  emotion  is  unsatisfied,  and  its 
expression  incomplete.  Hence  we  find  that  that  benevolence 
which  is  founded  upon  religious  emotion,  and  derives  its 
more  distant  origin  from  sexual  emotion,  always  shows 
itself  in  ways  which  involve  sacrifice  of  self.  While  the 
simply  benevolent  man  will  give  his  money,  his  time,  and 


.222  SANITY   AND   INSANITY. 

labour  freely  to  charitable  purposes,  without  diminishing 
his  means  of  enjoyment  by  more  than  this  expenditure 
necessarily  involves  ;  the  man  who  is  religiously  benevolent 
must  add  to  his  expenditure  of  money,  time,  and  work, 
certain  other  sacrifices,  which  are  made,  not  with  the  object 
of  benefiting  others,  but  simply  for  the  sake  of  sacrificing 
himself.  He  or  she — for  this  form  of  emotion  is  commoner 
in  women — must  undergo  fatiguing  labours,  must  abstain 
from  social  and  other  pleasures,  and  last,  but  not  least,  must 
assume  unbecoming  forms  of  dress. 

This  last  curious  and  common  outcome  of  a  state  of  life 
in  which  the  sexual  emotions  are  unsatisfied,  is  easily 
■explicable.  Ornaments,  throughout  the  entire  scale  of 
the  animal  kingdom,  are  assumed  and  developed  for  the 
purpose  of  attracting  the  opposite  sex,  and  have  no  other 
origin  or  reason  of  existence.  In  mankind,  dress  subserves 
this  function  first  and  most.  Among  savage  races  the  first 
rudiments  of  costume  are  assumed  with  a  view,  not  to  pro- 
tection from  the  weather,  nor  to  decency,  but  for  decorative 
purposes  only  ;  and,  in  the  most  civilized  and  cultured  of 
men  and  women,  a  very  large  proportion  of  the  care,  labour, 
and  money  that  are  expended  on  dress,  are  expended  for 
-decorative  purposes,  and  have  for  their  more  or  less  immediate 
motive  the  attraction  of  the  opposite  sex. 

This  prominence  and  importance  of  dress,  from  a  sexual 
point  of  view,  must  be  taken  together  with  the  law  that 
when  activities  fail  to  find  their  natural  and  legitimate 
outlet,  and  when  they  therefore  escape  in  ncAV  and  unaccus- 
tomed ways,  and  under  influences  that  are  to  some  extent 
abnormal,  such  activities  tend  to  escape  disorderly.  Having, 
for  want  of  natural  outlet,  failed  for  some  time  to  find 
expression,  the  activity  has  become  pent  up,  has  accumu- 
lated a  head  of  pressure  ;  and  hence,  when  outlet  in  a  new 
direction  is  at  last  found,  it  is  apt  to  escape  explosively, 
tumultuously,  and  in  excess.  Hence  it  is  that  so  many  of 
these  activities  which  begin  at  puberty,  and  which  are 
erring    and    mistaken    manifestations    of    a    normal    sexual 


THE    CAUSES    OF    INSANITY.  223 

instinct,  find  expressions  that  are  bizarre  and  excessive. 
Among  the  activities  which  then  become  prominent,  that 
of  self-sacrifice  is  the  most  predominant  and  important  ; 
and  having  regard  to  the  intimate  association  of  ornament 
with  the  sexual  function,  it  is  not  surprising  that  the  self- 
sacrifice  should  be  exhibited  with  special  prominence  in 
•connection  with  the  ornamental  properties  of  dress  ;  nor 
that,  w^hen  the  activity  of  self-sacrifice  becomes  disordered 
and  excessive,  a  studious  repulsiveness  should  be  substituted 
for  the  normal  attractiveness  of  costume. 

Hence  we  find  that  the  self-sacrificial  vagaries  of  the 
rejected  lover  and  of  the  religious  devotee,  own  a  common 
•origin  and  nature.  The  hook  and  spiky  kennel  of  the 
fakir,  the  pillar  of  St.  Simeon  Stylites,  the  flagellum  of  the 
monk,  the  sombre  garments  of  the  nun,  the  silence  of  the 
'Trappists,  the  defiantly  hideous  costume  of  the  hallelujah 
lass,  and  the  mortified  sobriety  of  the  district  visitor,  have 
at  bottom  the  same  origin  as  the  rags  of  Cardenio,  the  cage 
-of  Don  Quixote  de  la  Mancha,  and  the  yellow  stockings  and 
•crossed  garters  of  Malvolio. 

It  is  during  the  inactive  period,  when  the  activities  are 
accumulating,  and  before  they  have  found  even  their  limited 
and  modified  expression,  that  disorders  are  most  prone  to 
occur.  This  is  the  hysterical  period.  Here  is  a  head  of 
pressure  established,  an  accumulation  of  energies  struggling 
to  escape,  and  finding  no  outlet.  What  will  happen  ? 
Until  the  safety  valve  rises,  and  outlet  of  some  kind  is 
found,  there  will  be  evidence  of  the  accumulation  and 
presence  in  excess  of  vague,  indefinite,  diffused,  powerful 
feelings  belonging  to  the  consciousness  of  self.  The  con- 
sciousness of  self  will  be  the  predominant  element  instead 
of  the  subordinate  moiety  of  consciousness.  Events  and 
circumstances  will  be  viewed  in  their  relation,  not  to  each 
other,  but  to  self.  Self-consciousness  is  magnified — 
exaggerated  to  abnormal  dimensions.  Since,  ex  hypothesis 
definite  outlet  for  the  activities  is  not  found,  and  since  the 
vague  diffused  nature  of  the  emotions  themselves  does  not 


22  4  SANITY    AND    INSANITY. 

admit    of   definite  expression,  save    by  expenditure    on    an 
object,  the  evidence  of  the  existence  of  the  emotion  will  be 
of  the  vaguest  and  most  general  character  ;  but  since  the 
emotions  are  powerful,  and  pervading,  and  continuous,  the 
expression  will  be  emphatic  and  frequent.     What  are  the 
most   general    and    most   emphatic  modes  of  expression  of 
emotion  ?     Laughing    and    weeping.      Normally,    they    are 
the    expression    of  emotions  roused    by  the    experience    of 
circumstances,   of   some    ludicrous    or    painful    situation    in 
which  the  individual  is  placed  ;  but  in  these  cases  the  tide 
of  emotion  is  already  at  flood,  without  the  provocation  of 
external   circumstances,  and    in  these    cases,  therefore,  the 
expression  of  emotion  takes  place  without  provocation,  or 
on    provocation  that  is  insignificant  and  altogether  out  of 
proportion    to   the    display   made.     And    the  expression  is 
excessive,  not  merely  to  the  occasion  for  which   it  occurs, 
but  to  any  occasion.     Unprovoked  laughter  and  unprovoked 
weeping    are    most    commxon    manifestations   of    adolescent 
development.      At     the    same    time    other     evidences    of 
exaggerated    self-consciousness   become  apparent.     Nothing 
marks    more   conspicuously   and    emphatically   the    change 
from  the  child  to  the  woman,  than  the  easy,  spontaneous, 
unconstrained,  unstudied,  unself-conscious  gaze,  aspect,  and 
attitude  of  the  one  ;  and  the  restrained,  considered,  deliberate, 
self-attentive  regards  and    movements  of   the    other.     The 
one   intent  upon  the  external  object,  and    that  only  ;    the 
other    making  a    show    of   intentness   upon    the    matter  in 
hand,  but  thinking  more  of  the  way  in  which  her  actions 
may  impress  possible  or  actual  spectators.     The  one  unself- 
conscious,  the  other  eminently  self-conscious.     At  puberty, 
too,    embarrassment  first    becomes  a  serious    item   in    con- 
sciousness, and  embarrassment  is  positive  evidence  of  self- 
consciousness.     When    it    arises    from    inadequate   external 
provocation,    it    shows    excess    of    self-consciousness.     The 
external  evidence  of  embarrassment  is  the  blush  ;  and  hence, 
at   this    period    of  life,  blushing,   if   it    do   not    first    occur, 
becomes  a  far  more  frequent  and  pronounced  phenomenon 
than  either  before  or  afterwards. 


THE    CAUSES    OF    INSANITY.  22$ 

Among  the  other  manifestations  of  increased  self-conscious- 
ness is  the  craving  for  sympathy  and  fellowship  that  comes 
so  prominently  to  the  front  at  puberty.  The  child,  whose 
thoughts  are  all  externalized,  and  deal  with  circumstances 
and  events  without,  enjoys  the  society  of  its  fellows,  and  is 
by  nature  gregarious  ;  but  it  looks  on  its  playmates  with  far 
different  eyes  from  those  with  which  the  lover  in  posse 
looks  on  his  or  her  companions.  The  child  regards  its  play- 
mates and  associates  as,  like  itself,  in  pursuit  of  objects,  and 
engaged  in  interests,  that  are  external  to  both.  The  adolescent 
woman  seeks,  not  community,  but  mutuality  of  interests. 
She  desires  that  there  shall  be,  not  a  common  interest  with 
herself  in  some  external  object,  but  an  interest  in  herself 
which  she  can  mutually  reciprocate.  Such  an  interest  is 
one  of  the  primary  features  of  sexual  love,  and  at  the  period 
of  the  first  appearance  of  sexual  love  the  craving  for  this 
interest  appears.  As  with  so  many  of  the  other  phenomena 
of  puberty,  owing  to  causes  already  considered,  this  craving 
readily  becomes  disordered,  readily  becomes  excessive.  If 
it  fails  to  find  the  normal  and  legitimate  outlet  in  the 
affection  and  interest  of  an  individual  of  the  other  sex,  then, 
as  with  other  activities  similarly  placed,  it  becomes  pent 
up,  accumulates,  and  tends  to  find  disorderly  and  excessive 
expression.  Accordingly,  running  through  all  the  disorders 
of  hysteria,  we  find  the  craving  for  sympathy  always  present 
and  always  exaggerated.  Often  it  is  exaggerated  to  such  a 
degree  that  no  ordinary  manifestation  of  interest  or  sym- 
pathy would  satisfy  it  ;  and  hence,  to  obtain  satisfaction  for 
the  craving,  recourse  is  had  to  stratagems  and  devices  of 
various  kinds.  The  most  usual  occasion  for  an  increase  of 
the  interest  and  sympathy  with  which  people  are  commonly 
regarded  is  that  of  bodily  illness,  and  the  more  severe  the 
illness,  the  greater  the  sympathy  showm  ;  while  the  more 
unusual  and  remarkable  the  illness,  the  greater  is  the 
display  of  interest.  For  these  reasons  hysterical  persons 
are  extremely  apt  to  display  signs  of  bodily  ailment  ;  and 
the  ailments  whose  signs  are  thus  assumed  are  commonly 

i6 


2  26  SANITY   AND   INSANITY. 

either    of  great    severity,  or   of   bizarre    and    extraordinary 
character.     How   far   the    assumption    and    display   of    the 
signs   of    bodily    illness    are   consciously   and    deliberately 
invented,  manufactured,  and    shammed,  and    how  far  they 
involuntarily  and  unconsciously  impose  themselves  on  the 
patient  as  an  indirect  outgrowth  and  consequence    of   the 
craving,    are    questions    which   can    never    be    satisfactorily 
determined  ;  and  undoubtedly  the  two  elements  vary,  not 
only  in  different  cases,  but  from  time  to  time  in  the  same 
case.       Some   cases,  at    some    times,  are   cases   almost    en- 
tirely of  deliberate   imposture  ;  other  cases  at   some  times 
are   cases   in    which    the    patient    is    wholly    misled,    and 
imagines    that    the    pains    and    inabilities    that    she    un- 
doubtedly  feels    and    believes    in,   have  an  existence  apart 
from   the   craving   for    interest    and    sympathy  which,  un- 
knowingly  to    herself,   has  brought    them  into    being.     In 
the    majority    of    cases,    a    mass    of    vague,    voluminous, 
universally  diffused,  uneasy  feeling,  which  we  term,  when 
thus   formless    and    general,    a   craving,    comes    to    a    head 
locally,  becomes  intensified    in   some    one  direction,   bursts 
out,  as  it  were,  at  some  local  rent,  and  then  becomes  the 
hysterical  joint,  the  hysterical  back,  the  hysterical  tumour, 
the  hysterical  paralysis,  or  what  not.     Instead  of  a  general 
diffused  feeling  of  uneasiness,  there  is  a  concentrated  feeling 
of    similar    character,    which    is    localized    here   or    there. 
This  uneasy  feeling  is  referred  to  bodily  disease,  and  thus 
at    once   establishes  a  claim  for  the  payment  of  that  sym- 
pathy   which    is    so    sorely    craved    for.      Now    appears    a 
chance  of  getting  this  urgent  need  in  some  degree  satisfied^ 
and    the  patient  would  be   scarcely  human  if  she  did  not 
utilize    the    chance    thus    given,    and,  by   emphasizing   the 
expression  of  that    discomfort  which    she    really  feels,   put 
forth   a    stronger   claim  for  sympathy  than   she  is  on  that 
ground  entitled    to.     From  the  trifling    overacting   of  the 
languor  due  to  a  transient  headache,  there  is  every  degree 
up  to  instances  of  wilful  and  elaborate  imposture,  extend- 
ing  over   months   and   years,    and    involving,    it    may   be, 
ultimate  mutilation  of  the  patient  by  painful  operations. 


THE    CAUSES   OF    INSANITY.  227 

The  protean  character  of  the  manifestations  of  hysteria 
have  long  been  a  standing  source  of  marvel  to  physicians';  but 
it  seems  to  me  that  if  their  origin  is  in  that  craving  for 
interest  and  sympathy,  which,  it  is  admitted,  invariably 
accompanies  them,  the  varied  forms  that  they  assume 
are  to  some  extent  accounted  for.  It  is  obvious  that  the 
claim  to  interest  will  depend  not  so  much  on  the  seat  of 
the  malady  as  on  its  extraordinary  and  bizarre  character  ; 
and  that  the  claim  to  sympathy  will  rest,  not  on  the  seat 
or  nature  of  the  disorder,  but  on  its  gravity,  its  painful- 
ness,  and  the  extent  to  which  it  produces  disablement. 
Hence  we  find  that  all  the  manifestations  of  hysteria, 
extraordinarily  various  as  they  are,  are  distinguished  by 
certain  common  features.  They  are  either  of  extraordinary 
and  sensational  character,  or  they  are  accompanied  by 
manifestations  of  severe  pain  or  by  disablement.  In  the 
former  category  are  the  cases  of  abstinence  from  food,  of 
horribly  loud  and  discordant  cough,  of  loss  of  voice,  of  loss 
of  sight,  of  phantom  tumours,  of  inability  to  swallow,  to 
speak,  to  stand,  to  walk,  of  rigid  maintenance  of  certain 
postures,  of  trance  and  ecstasy,  of  vomiting  of  blood  or 
maggots  or  pins.  In  the  latter  are  the  cases  of  hysterical 
joint  affection,  the  hypersesthesia  of  the  senses,  so  that  the 
skin  cannot  be  touched  without  manifestations  of  agony  ; 
so  that  the  patient  lives  entirely  in  a  darkened  room, 
because  the  access  of  light  to  the  eye  gives  rise  to  spasm 
and  all  the  signs  of  pain  ;  so  that  not  even  a  whisper  can 
be  tolerated  ;  so  that  flowers  must  be  banished  from  their 
room  because  their  odour  is  intolerable. 

The  most  common  and  most  pronounced  symptom  of 
hysteria  is  the  hysterical  "  fit,"  an  occurrence  of  very  marked 
and  peculiar  character.  The  fit  is  a  sort  of  grotesque  cari- 
cature of  an  epileptic  fit.  The  patient  falls,  but  she  falls 
gently,  so  as  not  to  hurt  herself.  No  hysteric  ever  fell  into 
the  fire,  or  cut  her  head  severely  in  falling,  as  epileptics  so 
frequently  do.  Then  there  follows  a  quantity  of  aimless 
sprawling  and  floundering  about,  with  spluttering  at  the 


228  SANITY    AND    INSANITY. 

mouth,  graspings  of  the  hand,  and  gurghng   in  the  throat, 
and  after  a  time  the  patient  gets  up  none  the  worse. 

The  fit  is  a  manifestation   of    irregular  and  uncontrolled 
activity.     It  never  occurs  in  people  who  lead  busy  lives  and 
have  abundant  occupation  for  all  the  activities  of  their  minds 
and  bodies.    It  often  occurs  among  those  who  live  idle  lives, 
but  most  frequently  affects  those  who  are  moderately  active, 
but  whose  activities  are  but  one-sided  and  partial,  and  leave 
part  of  their  nature  unsatisfied.    In  idle  people  the  activities 
are  quiescent  all  round,  and  tend  to  cease  from  want  of  use  ; 
but   in  people  who  maintain   some  forms   of  activity,  their 
whole  nature  remains  capable  of  and   needing  activity,  and 
if  any  activities  be  unsatisfied,   they  will  be   apt  to  set  up 
disorderly   and    excessive   manifestations.     "  Seldom,"    says 
the    oldest    and    shrewdest    of  alienists,    "  should   you    see 
an  hired   servant,  a   poor    handmaid,  though  ancient,  that 
is  kept    hard    to    her    work,    and    bodily   labour,    a    coarse 
country  wench,  troubled  in  this   kind  ;  but  noble  virgins, 
nice  gentlewomen,  such  as  are  solitary  and  idle,  live  at  ease, 
lead  a  life  out  of  action  and  employment,  that  fare  well,  in 
great  houses  and  jovial  companies,  ...  of  weak  judgment, 
able    bodies,  and  subject  to  passions  [grandiores  virgincs^ 
saith  Mercatus,  steriles  et  vidiice  plcriimqiie)   such  for   the 
most  part  are  misaffected  and  prone   to  this  disease.     I  do 
not  so  much  pity  them  that  may  otherwise   be  eased,  but 
those  alone  that  out  of  a  strong  temperament,  innate  con- 
stitution,  are  violently  carried    away  with    this   torrent  of 
inward   humours,  and   though  very   modest  of  themselves, 
sober,  religious,  virtuous,  and   well  given  (as  so  many  dis- 
tressed maids  are)  yet  cannot  make  resistance,  these  grievances 
will  appear,  this  malady  will  take  place,  and  now  manifestly 
show  itself,  and   may   not   otherwise  be    helped."     Having 
availed  myself  so  freely  of  the  wisdom  of  my  predecessor, 
it  is  but  right  that  I  should  give  the  rest  of  a   quotation  so 
specially  appropriate  to  the  occasion.     "  But  where  am  I  ?  " 
he  cries,  "  Into  what  subject  have  I   rushed  ?     What  have 
I  to  do  with  nuns,  maids,  virgins,  widows  ?    I  am  a  bachelor 


THE    CAUSES    OF    INSANITY.  229 

myself,  and  lead  a  monastic  life.  .   .   .  nee  ego  sane  ineptiis 
qui  hcec  dixerim.     I  confess  'tis  an  indecorum." 

The  intimate  connection  of  hysteria  with  the  craving  for 
sympathy,  interest,  and  fellowship  is  shown  very  clearly  by 
the  effect  of  the  display  of  sympathy  towards  the  hysteric. 
Nothing  is  more  certain  or  more  striking  than  the  aggrava- 
tion of  the  symptoms  produced  by  such  a  display,  nothi-ng 
better  proved  than  the  amelioration  of  the  symptoms  that 
follows  a  judicious  display  of  indifference.  The  girl  who  has 
been  in  bed  and  unable  to  move  for  years  under  the  care  of  a 
silly,  fussy,  indulgent,  weak-minded  mother,  will  recover  in  a 
fortnight  when  taken  away  from  her  home  and  placed  under 
the  care  of  a  firm,  kind,  judicious,  strong-minded  woman. 

The  intimate  connection  of  hysteria  with  insanity  is  well- 
recognized.  It  is  not  merely  that  the  manifestations  of 
hysteria  major  graduate  into  insanity  by  insensible  grada- 
tions ;  that  in  certain  cases  we  are  puzzled  to  say  whether 
the  patient  is  insane  or  hysterical  ;  that  in  some  cases  the 
same  individual  is  at  one  time  plainly  hysterial,  and  at 
another  plainly  insane,  that  when  at  her  best  she  is  hysterical 
and  when  at  her  worst,  insane  ;  the  connection  shows  itself 
not  only  in  such  instances  as  these,  but  also  in  the  close 
alliance  with  insanity  that  most  manifestations  of  ordinary 
hysteria  display.  In  every  case  of  hysteria  of  ordinary 
severity  there  is  some  disorder  of  conduct.  The  patient 
either  lies  in  bed  without  the  disablement  of  bodily  illness, 
or  has  fits  of  prolonged  and  excessive  laughing  or  weeping, 
or  outbursts  of  "temper,"  of  screaming,  or  outbreaks  of 
destructiveness,  or  cruelty,  or  other  conduct  that  is  not 
adjusted  to  her  circumstances.  At  the  same  tinie,  there  is 
evidence  of  disorder  of  mind.  The  craving  for  sympathy 
and  interest,  which  is  natural  to  the  time  of  life  at  which 
hysteria  first  appears,  is,  in  all  cases  of  hysteria,  present  iti 
exaggerated  degree.  The  manifestations  of  emotion,  which 
are  so  prominent  a  feature  in  the  conduct,  indicate,  there 
is  no  doubt,  disorderly  and  excessive  phases  and  tides  of 
emotion    occurring    in    the    mind.     Anger,    vindictiveness, 


230  SANITY   AND   INSANITY. 

pity,  especially  self-pity,  religious,  and  other  emotions,  are 
present  in  excess,  and  out  of  proportion  to  the  circumstances 
of  the  individual  :  in  other  words,  they  are  disorderly. 
Intelligence,  too,  is  often  disordered  in  some  degree, 
although  the  disorder  of  this  side  of  mind  is  rarely  promi- 
nent, rarely  conspicuous,  and  is  consequently  often  overlooked 
and  disregarded  ;  and  this  is  the  reason  why  there  is  often 
so  much  difficulty  in  recognizing  the  positive  nearness  of 
relationship  between  hysteria  and  insanity.  If  we  find  a 
person  acting  strangely  and  in  a  way  that  is  manifestly 
unadjusted  to  her  surroundings,  and  if  yet  we  find  her  able 
to  reason  with  average  acuteness,  having  regard  to  her  sex 
and  age,  and  to  give  plausible  explanations  of  her  conduct, 
we  are  apt  to  conclude  that  there  is  no  intellectual  disorder  ; 
but  there  remains  often  this  residual  defect.  She  does  not 
herself  perceive  the  defect  in  her  own  conduct.  Conduct  is 
the  external  expression  of  intelligence.  Conduct  is  acted 
thought  ;  and  disorder  of  conduct  necessarily  implies  dis- 
order of  the  thought  of  which  it  is  the  expression. 

The  close  connection  between  hysteria  and  insanity  is 
displayed  again  in  the  similarity  between  the  received 
methods  of  treating  them.  The  first  thing  to  do  with  a 
case  of  acute  recent  insanity  is  to  effect  a  complete  change 
in  the  surroundings.  The  patient  is  taken  from  home  and 
placed  among  strangers  under  novel  and  unusual  circum- 
stances, and  this  is  the  first  step  and  the  first  condition  to 
recovery.  In  hysteria  also,  the  readiest,  speediest,  and  most 
reliable  means  of  cure  is  to  remove  the  patient  from  her 
home,  and  place  her  in  new  conditions  of  life.  In  the  one 
case  as  in  the  other,  what  is  termed  ''  moral  treatment  "  is 
among  the  most  powerful  recuperative  agents. 

Close  as  the  connection  of  hysteria  with  insanity  un- 
doubtedly is  ;  and  definitely  as  that  connection  has  always 
been  recognized,  yet  at  the  same  time  it  has  always  been 
held  as  a  matter  of  course  that  hysteria,  although  it  may  be 
associated  with  insanity  ;  although  it  may  graduate  into 
insanity  ;  although  it  may  display  the  disorder  of  conduct,  of 


THE    CAUSES    OF    INSANITY.  23 1 

feeling,  and  of  thought,  which  together  constitute  insanity  ; 
yet  it  is  itself  something  different  from  insanity.  Closely 
allied  as  the  two  undoubtedly  are,  and  puzzling  as  it  often  is 
to  distinguish  between  them,  yet  it  is  common  to  meet  with 
cases  of  hysteria  which  it  would  be  felt  to  be  an  outrage 
to  call  insanity.  The  question  arises,  What  is  this  subtle 
difference  which  distinguishes  things  so  closely  allied  in 
nature  and  appearance  ? 

The  difference  is,  that  while  in  insanity  the  part  of  the 
nervous  system  that  is  affected  is  the  very  highest  of  all — 
the  topmost  layers  of  the  topmost  strata  ;  in  hysteria  the 
seat  of  disorder  is  in  layers  immediately  below  the  topmost. 
If  we  imagine  the  highest  region  of  the  nervous  system  to 
contain  several  layers  of  slightly  different  degrees  of  altitude, 
then  in  insanity  the  highest  of  these  layers  are  affected.  It 
may  be  that  the  lower  layers  are  affected  also,  but  in  any 
case  the  most  superficial  stratum,  the  actual  surface  layer,  is 
disordered.  In  hysteria,  on  the  other  hand,  however  much 
and  however  widely  the  highest  nerve  regions  may  be 
affected,  there  always  remains,  so  long  as  the  case  is  one  of 
hysteria  alone,  above  the  disordered  layers,  a  stratum,  how- 
ever thin,  of  nervous  arrangements  which  still  continue  to 
carry  on  their  functions  normally.  Beneath  this  superficia 
film  there  may  be  several  layers,  all  belonging  to  the  highest 
stratum,  all  pertaining  to  that  system  of  centres,  to  that 
region  which  regulates  conduct,  and  whose  activity  is  accom- 
panied by  vivid,  active,  high-level  consciousness,  but  yet  not 
the  highest  of  all — still  having  above  them  a  superior 
authority  which  co-ordinates,  as  well  as  it  can,  their  erring 
activities,  and  provides  that  the  highest  manifestations  of  all 
shall  be  adapted  and  adjusted  to  circumstances.  Sometimes 
it  will  happen  that  the  disorder  in  the  lower  levels  increases, 
becomes  yet  more  uproarious,  and  invades  the  highest  level 
also  ;  and  in  such  cases  the  hysteria  will  merge  into  actual 
insanity  ;  but  more  commonly  the  disorder  remains  limited 
to  the  layers  just  below  the  highest,  and  the  manifestations 
are  those  of  hysteria  alone. 


232  SANITY   AND   INSANITY. 

The  evidence  in  support  of  this  view  appears  convincing. 
The  disorder  of  feehng — of  feehng  of  elaborate  and  elevated 
character,  of  the  more  elaborate  and  late-developed  emotions 
— indicates  without  a  doubt  that  the  region  of  the  nervous 
system  involved  in  the  disorder  is  a  very  elevated  region.  The 
disorder  of  conduct  proves  that  it  is  the  highest  stratum  of 
nervous  arrangements  that  the  physical  disorder  aflfects.  But 
there  are  other  manifestations  which  show  that  above  the 
disordered  region  there  are  some  arrangements  yet  intact, 
which  assert  some  authority,  and  endeavour  with  more  or  less 
success  to  control  and  regulate  the  disorderly  action  beneath 
them.  The  paroxysm  of  excessive  laughter  or  excessive  weep- 
ing is  described  as  "  uncontrollable,"  clearly  indicating  that 
the  necessity  for  control  is  appreciated.  Efforts  are  evidently 
made  to  suppress  the  excessive  manifestation.  Sometimes 
these  efforts  are  successful,  sometimes  they  are  not  ;  but  the 
fact  that  they  are  made  is  sufficient  proof  that  the  controlling 
authority,  that  is  to  say,  the  highest  nervous  region,  still 
exists,  still  acts,  and  even  if  its  action  be  ineffectual  in  con- 
trolling its  mutinous  subordinates,  yet  so  far  as  that  action 
goes,  it  is  normal  and  healthy. 

The  considerations  dealt  with  in  this  chapter  lead  us   to 
ne  following  conclusions.     At  the  period  of  puberty  new 
activities  are  added  to  the  body  ;  a  new  phase  of  develop- 
ment occurs.     This  development  takes   place  rapidly,  and 
on  that  account  its  products  are  apt  to  be  unstable.     The 
mental  changes'  that  take  place  at  puberty  are  in  the  mai  n 
additions  to  the  coencesthesis  or  consciousness  of  self,  and  are 
chiefly  three  ; — increase  of    self-consciousness  ;    craving  for 
self-sacrifice  :  and  craving  for  sympathy  and  interest  ;  all  of 
which  are  factors   in,  or    modifications  of,  sexual  emotion. 
Owing  to  the  disturbance  produced  by  the  rapid  addition  of 
the.se  new  faculties,  the  nervous  system  is  prone  at  puberty 
to  suffer   disorder  ;    and    when  disorder  occurs,  it    usually 
manifests  itself  in   some  excessive   or  bizarre  expression  of 
one  or  other  of  the  newly-added  faculties. 


CHAPTER  IX. 

THE    CAUSES    OF    INSANITY    {ContlUlLed). 

Indirect  Stresses  of  Internal  Origin  (continued). 

The  stress  of  puberty  tells  with  special  severity,  as  we  have 
seen,  on  the  female,  and  the  same  is  true  of  all  the  stresses 
connected  with  the  reproductive  function.  The  assumption 
of  the  reproductive  function  is  in  all  organisms  a  period  of 
storm  and  stress.  When  the  function,  from  being  potential, 
becomes  actual,  further  changes  occur,  and  the  changes  are 
of  a  twofold  nature.  On  the  one  hand,  the  gaining  of  an 
outlet  for  activities  is  always  ipso  facto  beneficial.  Activities 
that  find  no  outlet  must  of  necessity  produce  disorder,  and 
are  the  direct  occasion  of  unhappiness  and  harm.  The  un- 
fettered exercise  of  activities  is  always  a  source  of  satisfaction 
during  their  exercise,  is  always  of  beneficial  effect  to  the 
organism  at  large,  and  leaves  behind  it  an  abiding  feeling  of 
contentment,  which  is  the  mental  reflexion  of  an  enhance- 
ment of  the  general  well-being.  What  is  true  of  activities 
generally  is  especially  true  of  the  reproductive  activity.  If 
it  is  denied  its  natural  and  proper  outlet,  the  organism 
suffers.  Either  it  finds  expression  in  unnatural  and  im- 
proper ways,  or  it  breaks  out  disorderly,  or  it  is  transmuted, 
as  it  were,  into  other  activities,  whose  exercise  is  less  bene- 
ficial to  the  organism,  and  still  leaves  something  unsatisfied  ; 
leaves  the  organism  incomplete,  undeveloped,  one-sided.^ 

^  Burton  had  a  very  keen  insight  into  the  evils  of  sexual  abstinence : 
"  As  I  cannot  choose  but  condole  their  mishap  that  labour  of  this  infirmity, 
and  are  destitute  of  help  in  this  case,  so  I  must  needs  inveigh  against  them 
that  are  in  fault.  .   .  .  How  odious  and  abominable  are  these  superstitious 


234  SANITY   AND    INSANITY. 

On  the  other  hand,  the  function  of  reproduction  has  by 
its  very  nature  a  disintegrative,  deteriorating  influence  upon 
the  organism  in  which  it  occurs.  Down  at  the  bottom  of 
the  scale  of  hfe,  in  the  simplest  organisms,  reproduction  is 
effected  by  fission — by  the  division  of  the  simple  being  into 
parts,  each  of  which  takes  on  a  separate  life  and  becomes  a 
complete  individual.  The  gregarina  consists  of  an  almost 
homogeneous  jelly  enclosed  in  a  sac  or  body- wall.  When 
the  time  for  reproduction  arrives,  the  body  breaks  up  and 
divides  into  a  number  of  spindle-shaped  masses,  which 
remain  enclosed  in  the  sac.  Then  the  sac  bursts,  and  each 
spindle  develops  into  an  adult  gregarine.  Here,  in  this 
simplest  and  most  fundamental  instance,  the  performance  of 
reproduction  is  attended  by  the  entire  destruction  and  dis- 
appearance of  the  parent.  The  individual  ceases  to  exist 
as  an  individual,  and  exists  only  in  its  off"spring. 

In  the  higher  animals  and  in  the  human  race,  in  which 
reproduction  is  such  an  immensely  longer  and  more  elaborate 
process,  it  has  still  the  same  essential  nature.  The  parent 
still  persists,  as  an  individual,  it  is  true,  after  the  birth  of 
the  offspring.  The  individuality  of  the  parent  is  not 
-entirely  dissipated  and  lost  in  the  process  of  reproduction  ; 
but  still  that  process  is  not  effected  without  cost.  The 
whole  life  of  the  parent  is  not  lost  it  is  true,  but  a  part  of  it 
is  lost.  With  each  reproductive  act  the  bodily  energy  is 
diminished  ;  the  capacity  for  exertion  is  lessened  ;  the 
languor  and  lassitude  that  follow  indicate  the  strain  that 
has  been  put  upon  the  forces  of  the  body,  the  amount  of 
energy  that  has  been  abstracted  from  the  store  at  the 
disposal  of  the   organism.     Now,  the  seat   of  the  reservoir 

and  rash  vows  of  Popish  monasteries  !  so  to  bind  and  enforce  men  and 
women  to  vow  virginity,  to  lead  a  single  life,  against  the  laws  of  nature, 
opposite  to  religion,  policy,  and  humanity,  so  to  starve,  to  offer  violence,  to 
suppress  the  vigour  of  youth  by  rigorous  statutes,  severe  laws,  vain  per- 
suasions, to  debar  them  of  that  to  which,  by  their  innate  temperature,  they 
are  so  furiously  inclined,  urgently  carried,  and  sometimes  precipitated,  even 
irresistibly  led,  to  the  prejudice  of  their  soul's  health,  and  good  estate  of 
body  and  mind." 


THE   CAUSES   OF    INSANITY.  235 

of  energy  is  the  nervous  system,  and  any  drain  upon  the 
•energies  of  the  body  is  a  drain  on  the  nervous  system, 
whose  highest  regions  will,  on  the  general  grounds  already 
familiar,  be  the  first  and  most  affected.  Hence  the  repro- 
ductive act  has  an  effect  on  the  highest  regions  of  the 
nervous  system  which  is  of  the  nature  of  a  stress,  and  tends 
to  produce  disorder. 

With  a  normally  constituted  organism  the  stress  of  the 
reproductive  act  is  not  sufficient  to  produce  disorder,  unless 
it  is  repeated  with  undue  frequency  ;  on  the  contrary,  by 
providing  a  natural  and  legitimate  outlet  for  surplus  activity, 
its  influence  is  distinctly  beneficial.  But  in  an  organism 
whose  energies  are  naturally  defective,  the  tendency  of  the 
reproductive  act  will  be  to  increase  the  deficiency  ;  and  in 
an  organism  which  is  inherently  below  the  normal  stability, 
the  tendency  of  the  stress  of  the  reproductive  act  will  be  to 
produce  disorder.  This  tendency  will  be  especially  severe 
when  indulgence  in  the  sexual  act  is  begun  at  too  early  an 
age. 

Hence  we  find  that  a  certain  number  of  cases  of  insanity, 
amounting  to  about  2^  per  cent,  of  the  total  number  that 
occur  annually  in  this  country,  are  attributed  to  sexual  ex- 
cesses. In  this  estimate  there  is,  however,  a  source  of  error,  for 
the  tendency  of  the  normal  organism  is  to  spread  its  expendi- 
ture evenly  throughout  all  the  avenues  of  escape  provided 
for  it.  Hence,  if  one  of  these  channels  is  more  favoured 
than  is  due,  and  is  permitted  to  draught  off  more  than  its 
due  proportion  of  the  common  store  of  energy,  it  indicates 
either  that  the  facilities  for  escape  through  this  channel  are 
unusually  copious,  or  that  the  organism  possesses  an  inherent 
tendency  to  dissipate  energy  to  excess  in  that  direction. 
Cases  in  which  the  facilities  for,  and  temptations  to,  unduly 
excessive  sexual  indulgence  do  occasionally  occur,  and,  if 
yielded  to,  do  produce  deleterious  results  ;  but  the  majority 
of  cases  in  which  sexual  excess  can  rightly  be  attributed  as 
a  cause  of  insanity,  are  cases  of  the  second  class.  Such 
excess    is    not    commonly    indulged    in  unless  by   inherent 


236  SANITY    AND    INSANITY. 

defect,  or  vice  in  the  constitution  of  the  organism,  there  is 
a  decidedly  undue  proneness  for  the  expenditure  of  energy  in 
this  direction  ;  and  in  such  cases  the  inheritance  of  this 
tendency  must  be  regarded  as  a  factor  in  the  production  of 
the  insanity  of  equal  importance  with  the  stress. 

The  variations  which  occur  in  the  tendency  for  energy  to 
be  directed  into  this  channel  are  normally  very  wide.  In 
some  individuals  it  is  insignificantly  small,  in  others  again  it 
is  very  powerful.  Now,  whenever  a  faculty,  function,  or 
structure,  is  found  to  undergo  wide  variations  within  the 
limits  of  the  normal,  it  is  always  found  that  such  a  faculty 
tends  frequently  to  exceed  the  normal.  The  tendency  to 
vary,  which  always  exists,  will  occasionally  be  excessive.  An 
organ  or  a  function  which  maintains,  throughout  the  majority 
of  individuals,  a  nearly  constant  ratio  to  the  rest  of  the 
structures  or  functions,  will  seldom  be  found  developed  to 
excess  ;  but  one  which,  within  the  limits  of  health,  largely 
exceeds  the  average  in  some  people,  and  falls  short  of  it  in 
others,  will  be  liable,  in  a  small  minority  of  cases,  to 
development  that  is  excessive,  or  disorderly,  or  both.  For 
instance,  the  salivary  glands,  by  whose  secretion  the  mouth 
is  kept  moist  and  the  food  is  lubricated,  are  remarkably 
constant  in  size  and  activity.  They  grow  uniformly  with 
the  growth  of  the  body,  they  attain  in  every  person  to 
similar  dimensions,  and  their  activity  in  all  is  about  the 
same.  Consequently,  we  find  that  it  is  very  rare  for  these 
glands  to  attain  an  excessive  development — to  grow  to  an 
excessive  size — and  rare  for  them  to  take  on  disorderly 
development — to  become  the  seat  of  tumour  or  of  cancerous 
growth.  On  the  other  hand,  the  breast,  a  gland  of  precisely 
similar  structure  and  nature  to  the  salivary  gland,  varies 
greatly  in  size  and  activity  both  in  different  individuals  and 
in  the  same  individual  at  different  times.  In  men  it  is 
altogether  absent.  In  some  women  it  is  almost  absent  ;  in 
others  it  is  greatly  beyond  the  average  in  size.  In  all  women 
during  and  after  pregnancy  it  is  greatly  increased  in  size 
and  activity.     In   some  women   its  activity  is  great  and  its 


THE   CAUSES   OF    INSANITY.  237 

supply  of  milk  copious  ;  others  have  not  sufficient  milk  to 
nourish  their  offspring.  Correspondingly  with  these  wide 
limits  of  variation  within  the  normal,  we  find  that  the 
limits  of  the  normal  are  often  exceeded.  Not  infrequently 
the  development  of  the  breast  is  so  excessive  as  to  amount 
to  a  veritable  deformity,  and  even  occasionally  to  necessitate 
amputation  ;  and  of  all  the  seats  of  cancer  the  breast  is  the 
most  common.  In  the  same  way,  the  tendency  to  the 
expenditure  of  energy  through  the  satisfaction  of  the  sexual 
passion,  as  it  normally  varies  within  wide  limits,  both  in 
different  individuals  and  in  the  same  individual  at  different 
times,  is  specially  subject  to  variations  which  exceed  the 
limits  of  the  normal.  This  is  the  explanation  of  the  occa- 
sional occurrence  of  those  wretched  beings  whose  whole 
attention  is  absorbed  and  whose  whole  time  is  occupied  with 
this  one  aim  and  object.  Cases  so  extreme  are  not  met  with 
outside  the  walls  of  lunatic  asylums,  but  cases  in  which  the 
tendency  is  excessive  in  a  minor  degree  are  moderately 
common  ;  and  the  indulgence  in  this  proclivity  is  a  fruitful 
source  of  that  deterioration  of  the  higher  powers  of  the 
nervous  system  which  is  the  foundation  of  insanity. 

It  has  been  said  in  a  previous  chapter  that  the  function 
of  the  male  element  in  the  process  of  reproduction  is  to 
give  to  the  germ  an  impetus  sufficient  to  carry  it  on  through 
the  long  process  of  development.  The  actual  material  addi- 
tion made  by  the  male  to  the  mass  of  the  offspring  is 
insignificant.  The  whole  and  sole  utility  of  the  union  of 
the  male  element  with  the  female  is  the  additional  impetus 
thereby  imparted  to  the  process  of  development.  This 
being  so,  it  will  appear  clear  that  while  the  main  contribu- 
tion of  the  female  to  the  joint  result,  to  the  constitution  of 
the  offspring,  is  the  matter  of  which  the  body  is  composed, 
the  contribution  of  the  male  is  the  energy  which  animates 
the  matter. 

Hence,  excessive  indulgence  by  the  female  in  the  sexual 
act  is  comparatively  harmless  to  her  unless  it  results  in 
unduly  numerous  and  frequently  occurring  offspring. 


238  SANITY    AND    INSANITY. 

Hence  the  danger  to  the  female — the  draught  upon  her 
vitaHty,  the  circumstance  which  renders  the  reproductive 
function  a  danger  to  her,  is  in  part  the  loss  of  energy,  and  in 
part  the  subtraction  of  matter  ;  while  in  the  male  it  is  the 
dissipation  of  energy  only  that  is  to  be  feared. 

For  this  reason  we  find  that  undue  frequency  of  sexual 
congress  is  not  attended  in  the  female  by  the  same  ill  results 
that  follow  it  in  the  male.  In  the  latter,  the  repeated  loss 
of  energy  eventuates  at  last  in  a  state  of  anergy,  apathy,, 
lethargy,  and  dementia.  The  tension  of  energy  in  the  nervous 
system  is  reduced  to  the  lowest  ebb,  and  all  the  manifesta- 
tions of  the  existence  of  this  energy  are  wanting  or  are 
exhibited  in  feeble  and  perfunctory  shape.  The  condition  is- 
one  of  dementia — there  is  the  want  of  mind,  the  inability  ta 
perform  mental  operations  of  even  moderate  difficulty,  the 
dulness  and  slowness  of  feeling,  the  loss  of  all  the  higher 
emotions  and  of  many  of  the  lower  ones  also,  that  charac- 
terize dementia.  There  is  the  deficiency  of  movement,  the 
absence  of  muscular  exercise,  the  inability  to  make  exer- 
tions that  are  at  all  prolonged  or  continuous,  the  general 
degradation  of  conduct,  the  loss  of  all  the  higher  attributes 
of  humanity,  and  the  retention  of  only  the  lower  and  more 
animal  characteristics.  Such  are  the  results  of  the  indul- 
gence of  the  sexual  passion  in  great  excess.  When  the 
indulgence  is  less  excessive,  the  degradation  is  less  pro- 
found, but  in  every  case  there  is  degradation,  and  in  every 
case  the  deterioration  is  of  the  nature  of  dementia,  that  is 
to  say,  it  is  a  manifestation  of  deficiency  in  the  amount  of 
the  stored  energy. 

In  the  female  the  circumstances  are  different.  While  her 
contribution  to  the  offspring  is  in  part  one  of  energy,  it  is 
chiefly  material.  From  her  the  offspring  derives  its  bulk, 
its  mass,  the  material  ingredients  of  its  composition  ;  and  to 
provide  these  is  the  chief  office  of  the  mother.  Hence  the 
female  does  not,  as  a  rule,  suffer  greatly  from  undue  repeti- 
tion of  the  sexual  act,  even  when  the  indulgence  is  very 
prolonged  and  excessive.     The  stress  upon  her  is  not  in  the 


THE    CAUSES   OF    INSANITY.  239 

sexual,  but  in  the  reproductive  act.  It  is  not  from  sexual 
congress,  but  from  child-birth,  and  its  attendant  circum- 
stances, that  danger  to  her  arises. 

We  have  seen  how  far  more  important  the  assumption  of 
the  reproductive  function  is  to  woman  than  to  man  ;  how 
much  more  numerous,  more  bulky,  and  more  important  are 
the  alterations  and  additions  to  her  bodily  structure  at  the 
time  of  puberty  than  are  those  to  the  structure  of  the  male,, 
and  correspondingly  how  much  greater  the  disturbance  that 
attends  their  development.  This  greater  prominence  and 
importance  of  the  reproductiv^e  function  in  the  female  is- 
continued  throughout  her  life.  It  occupies  a  far  larger  pro- 
portion of  her  life  than  it  does  in  the  male.  Not  merely 
has  she,  on  each  occasion  on  which  she  produces  offspring,  to 
provide  for  three-quarters  of  a  year  the  whole  materials  for 
its  growth  ;  not  only  has  she  to  pass  through  on  each  occa- 
sion the  storm  and  stress  of  delivery  ;  not  only  has  she  for 
a  further  nine  months  to  supply  it  still  at  her  own  cost  with 
materials  for  nutrition  and  growth  ;  not  only  has  she  to- 
suffer  under  this  prolonged  period  of  stress  on  each  occasion 
on  which  she  produces  offspring  :  but  during  every  month 
she  undergoes  a  miniature  pregnancy,  and  at  each  menstrual 
period  she  passes  through  a  miniature  delivery.  Her  whole 
life,  from  puberty  to  her  climacteric,  is  passed  either  in  pro- 
ducing and  nourishing  offspring,  or  in  preparing  for  the 
production  and  nourishment  of  offspring. 

As  has  been  said,  the  female,  in  giving  life  to  her  off- 
spring parts  with  a  portion  of  her  own.  Just  as  the 
gregarina  breaks  up  its  entire  self  into  a  number  of  separate 
young  individuals,  and  in  giving  life  to  them  loses  her  own  ; 
so  the  higher  animal,  in  separating  off  from  itself  a  portion 
of  its  being  as  a  new  individual,  loses  thereby  a  portion  of 
her  own.  The  loss  in  the  latter  case  is  much  less  complete 
than  in  the  former,  and,  unlike  the  former  case,  the  loss  is 
in  the  latter  capable  of  reparation,  so  that,  after  a  lapse  of 
time,  little  or  no  detriment  remains  ;  but  none  the  less  is 
there  at  the  time  an  actual  loss  of  a  portion  of  the  life — of 


240  SANITY    AND    INSANITY. 

a  portion  of  the  power  and  capacity  of  living.  For  the 
time,  the  amount  of  Hfe  existing  in  the  female,  the  degree 
of  vitality,  the  power  of  dealing  with  circumstances,  the 
ability  to  throw  off  injurious  influences,  is  reduced.  The 
loss  is  evidenced  by  her  weakness,  her  prostration,  her  in- 
capacity for  exertion,  her  increased  obnoxiousness  to 
damaging  influences,  to  the  poisons  of  fever,  to  the  stress 
of  anxiety,  to  the  ill  effects  of  exposure  and  privation.  The 
debility  of  the  parturient  woman,  and  her  increased  liability 
to  suffer  from  noxious  influences,  are  sufficiently  notorious. 
In  short,  the  whole  reproductive  process  is  in  woman  an 
occasion  of  stress,  of  diminution  of  the  normal  energies. 
And  the  stress  is  not  a  local  stress  it  ;  affects  the  organism  at 
large  and  generally.  Hence  the  highest  nerve  regions, 
which  represent  the  organism  at  large,  are  specially  liable 
to  suffer.  The  main  weight  of  the  stress  bears  on  the 
nervous  system,  and  especially  on  the  higher  regions  of  the 
nervous  system  ;  and  hence  the  performance  of  the  repro- 
ductive function  is  in  w^oman  always  attended  by  a  liability 
to  failure  of  the  highest  nervous  arrangements.  In  women 
whose  nervous  systems  are  constituted  with  normal  stability, 
the  stress  is  productive  of  weakness,  of  diminution  in  the 
power  and  energy  with  which  the  nervous  system  should 
perform  its  functions.  It  is  not  enough  in  them  to  produce 
great  disorder,  and  the  minor  defect  from  which  they  suffer 
is  soon  repaired.  Yet  even  in  the  healthiest  women  preg- 
nancy is  attended  by  certain  slight  manifestations  of  dis- 
order— by  longings,  by  irritability,  by  emotional  displays 
that  are  excessive  and  are  for  them  unusual.  Every  woman 
in  child-birth  displays  exaggerated  manifestations  of  emotion 
which,  if  occurring  frequently  and  at  other  times,  would 
certainly  be  considered  insane.  But  in  women  whose 
nervous  systems  are  less  stably  constituted,  in  women 
who  have  derived  from  heredity  an  undue  instability  of 
tissue,  the  consequences  are  graver.  The  incidence  of  so 
urgent  a  stress  upon  a  nervous  system  of  less  than  normal 
stability  is  liable  to  produce  a  degree  of  weakness  that  quite 


THE   CAUSES   OF    INSANITY.  24I 

disables  it  from  performing  its  highest  functions — to  produce 
that  definite  and  positive  disorder  that  is  evidenced  in 
insanity.  Hence  in  women  who  are  by  heredity  predis- 
posed to  insanity  the  process  of  reproduction  is  attended 
with  special  danger.  Hence,  in  a  considerable  proportion 
of  the  cases  of  insanity  that  occur  in  women,  the  insanity 
appears  for  the  first  time  during  pregnancy,  or  at,  or  imme- 
diately after,  child-birth.  In  nearly  10  per  cent,  of  the 
women  who  become  insane,  the  insanity  occurs  at  this 
period. 

It  has  been  said  that,  at  each  menstrual  period,  a  woman 
passes  through  what  is  practically  a  miniature  delivery. 
Whatever  stress  attends  the  process  of  child-birth  occurs  in 
a  much  milder  and  less  aggravated  degree  at  each  menstrual 
period  ;  and  hence  at  these  periods  we  should  expect  to  find 
evidence  of  stress — evidence  of  some  slight  defect  in  the 
working  of  the  nervous  system  in  those  in  whom  that 
system  is  of  normal  stability  ;  evidence  of  graver  defect  in 
those  whose  nervous  systems  are  inherently  below  the 
normal  standard.  And  such  evidence  we  do  find.  Every 
woman  at  her  menstrual  period  is  less  active  than  at  other 
times.  She  suffers  more  or  less  from  languor,  from  apathy, 
from  disinclination  for  exertion  ;  she  is  at  such  times  less 
prone  to  be  energetic,  and  more  easily  fatigued.  She  is 
unusually  irritable,  more  readily  moved  to  tears.  That  is  to 
say,  her  nervous  system  is  acting  less  efficiently  than  usual. 
In  women  of  naturally  unstable  nervous  organization,  the 
effects  and  signs  of  stress  at  the  menstrual  periods  are  much 
graver  and  more  conspicuous.  The  hysterical  woman  is 
especially  liable  to  fits  and  other  marked  manifestations  of 
hysteria  at  her  menstrual  periods.  The  insane  woman  is 
specially  liable  to  exaggerations  of  her  insanity  at  her 
menstrual  periods.  More  than  one  case  has  been  recorded 
in  which  a  woman  became  insane  at  each  menstrual  period, 
and  was  sane  in  the  intervals. 

While  the  greatest  stress  connected  with  the  reproductive 
function  attends  the  actual  process  of  child-birth,  the  entire 

17 


242  SANITY   AND   INSANITY. 

process  from  the  beginning  of  pregnancy  to  the  cessation  of 
suckling  is  a  strain  upon  the  resources  of  the  organism,  is 
a  source  of  stress  to  the  nervous  system,  and  is  a  cause  of 
disorder  in  those  whose  nervous  systems  are  inherently 
faulty.  Of  the  10  per  cent,  of  insane  women  whose  insanity 
dates  from  the  process  of  reproduction,  7^  per  cent,  date 
from  the  time  of  child-birth,  2^  per  cent,  occur  during 
suckling,  and  i  per  cent,  during  pregnancy. 

Throughout  the  fertile  period  of  her  life,  woman  is  subject 
to  the  periodic  recurrence  of  stresses  of  varying  intensity, 
arising  from  the  activity  of  her  reproductive  function  ; 
beginning  with  the  stormy  period  of  puberty,  rising  in 
minor  culminations  at  each  monthly  period,  and  reaching 
at  each  successive  child-birth  a  degree  which  disorders  for 
the  moment  even  the  strongest  and  stablest  nervous  system, 
and  produces  in  those  which  are  inherently  defective,  a 
disorder  which  is  profound  and  prolonged,  or  slight  and 
transient,  according  to  the  character  of  the  nervous  system 
on  which  it  acts.  Even  when  the  fertile  period  of  life 
reaches  its  close,  the  cessation  of  the  reproductive  function 
is  attended  by  stresses  that  are  inferior  to  those  only  which 
accompanied Jts  development.  At  her  climacteric,  between 
the  ages  of  forty  and  fifty,  woman  undergoes  a  process  of, 
as  it  were,  inverted  puberty.  The  organs  and  functions 
which  she  acquired  with  so  much  disturbance,  and  which 
have  been  throughout  her  life  so  fertile  a  source  of  trouble 
and  danger,  now  undergo  involution.  They  subside  once 
more  into  the  quiescence  from  which  at  puberty  they 
emerged  ;  but  even  when  they  go,  they  cannot  go  quietly. 
When  the  devil  was  cast  out  of  the  deaf-and-dumb  boy,  he 
did  not  go  quietly,  but  cried,  and  rent  him  sore,  and  left 
him  as  one  dead  ;  and  when  the  reproductive  functions 
depart  from  a  woman,  they  make  their  exit,  as  it  were, 
unwillingly,  and  with  a  demonstration  of  rage.  They 
give  their  possessor  a  parting  kick.  In  other  words, 
the  process  of  involution  is  like  the  process  of  evolution, 
attended   with   stress   and    difficulty.       The   rapid   loss   of 


THE    CAUSES   OF   INSANITY.  243 

functions,  no  more  than  the  rapid  addition  of  functions, 
can  take  place  without  disturbing  the  general  balance,  the 
equilibrium  of  the  distribution  of  energy.  When  activities 
and  potentialities  for  activity  are  added  to  a  person's  nature, 
the  addition  is  necessarily  accompanied  by  disturbance, 
which  is  great  in  proportion  to  the  amount  of  activity  that 
is  added,  and  to  the  rapidity  with  which  the  addition  is 
made.  And  conversely,  when  activities  and  potentialities 
for  activity  are  withdrawn,  the  withdrawal  is  accompanied 
by  disturbance,  w^hich  is  great  in  proportion  to  the  amount 
withdrawm,  and  to  the  rapidity  with  which  that  amount  is 
abstracted. 

Hence  it  is  found  that  in  women  in  whose  nature  and  in 
whose  life  the  sexual  and  reproductive  functions  have  absorbed 
a  large  proportion  of  the  total  activities,  the  disturbance 
that  attends  withdrawal  of  these  activities  is  greater  than  in 
those  in  whom  these  functions  have  been  less  active  ;  and 
when  the  involution  and  loss  of  the  climacteric  take  place 
rapidly,  they  produce  more  disturbance  than  when  the 
change  is  spread  over  a  longer  period  of  time.  Hence  we 
see,  not  only  why  some  women  become  insane  at  the  change 
of  life,  but  also  why  the  vast  majority  pass  through  this 
period,  not  indeed  without  evidence  of  disturbance,  but 
without  the  disturbance  attaining  the  gravity  of  actual  in- 
sanity. To  produce  this  extreme  effect  there  must  be  a 
concurrence  of  favouring  conditions.  The  nervous  system 
must  have  been  inherently  unstable  ;  and  the  change  must 
have  been  unduly  grave,  or  unduly  rapid,  or  both. 

Bearing  in  mind  the  principles  already  enunciated,  it  will 
not  appear  strange  that  the  climacteric  period,  w^hich  is^in 
all  women  a  period  of  stress  and  of  danger,  and  which  is  in 
some  women  the  occasion  of  an  outbreak  of  actual  insanity, 
is  the  signal  in  others  for  the  disappearance  of  an  insanity 
which  existed  so  long  as  the  reproductive  functions  were 
active.  If  the  organism  has  never  been  able  to  so  rearrange 
its  energies  as  to  adapt  them  to  the  new  conditions  brought 
about  by  the  addition  of  the  reproductive  functions,  and  if 


244  SANITY   AND   INSANITY. 

in  consequence  there  has  been  disorder  during  the  time  of 
activity  of  these  functions,  then  it  is  easy  to  understand  that 
when  the  reproductive  functions  cease,  and  the  disturbing 
element  is  withdrawn,  the  equiUbrium  of  activities  may  be 
re-established,  and  the  disorder  may  settle  down  once  more 
into  normal  action.  Whatever  the  explanation,  it  is  an  in- 
disputable fact,  that  a  certain  proportion  of  insane  women 
do  recover  from  their  insanity  upon  the  establishment  of  the 
menopause. 

Of  the  indirect  stresses  of  internal  origin,  those  which 
accompany  the  general  commotions  that  occur  in  connection 
with  the  reproductive  functions  are  the  most  important  and 
the  most  frequently  occurring.  Other  stresses,  there  are, 
however,  of  this  class,  produced  by  general  commotions 
pervading  the  entire  organism,  but  not  directly  connected 
with  the  reproductive  functions.  \Yhen  a  person  suffers 
from  a  fever  or  other  general  malady  affecting  his  whole 
organism,  insanity  is  apt  to  occur,  as  we  have  seen,  from 
the  direct  stress  of  the  poison  in  the  blood  upon  the  superior 
nervous  system.  But  in  addition  to  this  mode  of  action, 
fevers  may,  acting  in  quite  another  way,  produce  insanity. 
In  fever  the  entire  mass  of  the  blood  is  vitiated  by  the 
contained  poison.  The  blood  is  supplied  by  its  vessels  to 
every  part  of  the  organism.  The  entire  mass  of  the  tissues 
are  continually  bathed  and  soaked  in  the  blood,  and  if  the 
blood  contain  a  noxious  ingredient,  this  ingredient  is  dis- 
tributed to  every  part  of  every  tissue  of  the  body.  The 
noxiousness  of  the  new  ingredient  in  the  blood  in  fevers 
depends,  not  so  much  on  its  action  on  the  blood  itself,  as  on 
its  action  on  the  tissues  to  which  the  blood  carries  it.  The 
blood  goes  to  the  tissues  to  nourish  them,  and  to  carry  away 
their  waste.  It  is  at  once  the  commissariat  and  the 
scavenger  of  the  body.  If  it  contains  an  ingredient  which 
is  capable  of  modifying  the  process  of  nutrition,  it  is  evident 
that  the  process  of  nutrition  throughout  the  whole  body  will 
be  modified.  Amongst  the  tissues  so  modified  are  those  of 
the  nervous  system,  and  the  copiousness  with  which  the 


THE    CAUSES   OF   INSANITY.  245 

blood  is  supplied  to  them,  and  the  high  degree  of  activity 
which  is  normal  to  the  nutritive  process  in  the  grey  matter, 
will  ensure  that  whatever  modification  nutrition  undergoes 
in  the  body  generally,  will  be  felt  with  especial  severity  in 
the  superior  nerve  regions. 

That  fevers  and  other  "constitutional"  or  general  maladies 
do  affect  in  some  way  the  nutrition  of  the  whole  body,  is 
rendered  evident  by  certain  signs  that  follow  them.  The 
affection  of  nutrition  that  is  now  dealt  with  is  a  different 
matter  from  the  direct  poisoning  of  the  superior  nerve 
centres  that  occurs  upon  the  invasion  of  a  fever,  and  that 
has  already  been  dealt  with  among  the  direct  stresses.  The 
process  of  nutrition  in  the  nervous  system  has  a  two-fold 
aspect.  A  continuous  supply  of  blood  from  moment  to 
moment  is  necessary  to  enable  the  nervous  arrangements  as 
they  then  exist  to  continue  in  action.  If  the  blood  supply 
is  suddenly  cut  oif,  as  by  failure  of  the  heart  in  fainting, 
the  action  can  no  longer  continue.  The  nervous  system 
ceases  to  act,  and  the  individual  falls  paralysed  and  un- 
conscious. If,  instead  of  ceasing  altogether,  the  blood  supply 
is  vitiated  by  the  addition  of  a  poison,  the  nervous  system 
does  not  cease  to  act,  but  its  action  is  defective  and  dis- 
ordered. At  the  same  time  that  the  temporary  changes 
which  constitute  the  functional  activity  are  going  on,  there 
are  also  going  on  changes  of  a  more  permanent  nature — 
changes  whereby  the  tissues  are  maintained  in  their  integrity 
in  spite  of  the  wear  and  tear  of  action  ;  changes  by  which 
the  modifications  of  structure  that  result  from  functional 
activity,  are  dealt  with,  and  either  fixated  or  deleted  ; 
changes  of  maintenance  and  repair.  We  may  compare  the 
two  sets  of  changes  with  those  that  go  on  in  a  steam  engine 
during  its  working.  On  the  one  hand,  the  stokers  are 
continually  adding  fresh  coals  to  keep  the  machine  going  ; 
on  the  other,  the  engineers  are  always  on  the  alert,  tighten- 
ing a  bolt  here,  removing  rust  there,  adding  oil  in  another 
place,  repacking  a  valve,  or  renewing  a  bearing.  The  one 
is^a  change  in  the  way  of  working,  the  other  is  a  change  of 


246  SANITY   AND   INSANITY. 

structure.  Noav  if  the  quality  of  the  blood  that  is  supplied 
to  the  nervous  system  is  altered,  it  is  obvious  that,  not  only 
will  the  first  set  of  changes,  which  affect  the  functional 
activities  from  moment  to  moment,  be  altered,  and  the 
altered  results  be  immediately  seen  in  altered  manifestations  ; 
but  the  second  and  more  permanent  set  of  changes  will  be 
altered  likewise.  The  nourishment  of  the  brain  will  be 
altered ;  its  structure  will  be  modified  ;  and  this  modification 
of  structure  will  exhibit  itself  in  an  alteration  in  the  way 
of  working  that  persists  long  after  the  change  in  the  blood 
has  passed  away  and  been  forgotten.  When  pigs  are  fed  on 
madder  their  bones  become  coloured  ;  and  long  after  the 
madder  has  been  discontinued  in  the  food,  and  long  after  it 
has  ceased  to  be  a  constituent  in  the  blood,  the  colour 
remains  in  the  bones.  Weeks  or  months  after  a  person  has 
suffered  from  fever,  or  other  general  malady,  the  nails  are 
found  to  have  ridges  on  them,  the  hair  falls  off,  the  skin 
desquamates,  the  growing  teeth  are  found  to  take  abnormal 
shapes.  And  similarly,  when  the  nervous  system  is  fed  on 
vitiated  blood,  the  effect  of  the  faulty  nutrition  will  remain 
in  the  brain  long  after  the  blood  has  been  freed  of  its 
mischievous  ingredient. 

Hence  we  find,  not  only  that  the  invasion  and  acute 
period  of  fever  are  accompanied  by  delirium,  but  that,  after 
the  fever  is  over,  and  during  the  period  of  convalescence, 
the  mind  is  always  a  little  below  the  normal,  and  is  often 
perceptibly  weakened.  In  this,  as  in  all  other  cases,  we  find 
that  an  effect  which  is  always  present  in  a  slight  degree, 
assumes,  in  certain  cases  in  which  the  stress  was  unusually 
great,  or  the  conditions  unusually  favourable,  much  graver 
proportions  ;  and  just  as  it  occasionally  happens  that  the 
debility  of  body,  that  is  left  after  a  fever,  is  so  extreme  as  to 
result  in  a  general  break  down,  and,  for  instance,  to  lead 
directly  to  consumption  ;  so  it  occasionally  happens  that  the 
debility  of  mind,  that  is  concomitant  with  the  bodily  weak- 
ness, exhibits  itself  in  extreme  form,  and  becomes  actual 
insanity. 


THE   CAUSES   OF    INSANITY.  247 

If  we  bear  in  mind  the  fact  that  every  process  that  goes 
on  in  the  body  has  normally  a  representation  in  the  highest 
regions  of  the  nervous  system,  modifies  in  some  degree  the 
nerve  currents  which  go  to  these  regions,  and  so  impresses 
itself  to  some  extent  on  the  mode  and  degree  of  their  action, 
and  indirectly  modifies  the  mental  states  which  are  the 
accompaniment  of  their  action  ;  it  will  ^be  easy  to  under- 
stand that  a  general  alteration  in  the  way  that  the  tissues 
throughout  the  body  have  been  nourished  must  produce  a 
sensible  modification  in  the  currents  going  from  the  whole 
body  to  the  higher  nerve  regions,  must  give  rise  to  stress 
upon  them,  and  must  tend  to  disorder  their  action.  Thus 
we  see  that  there  are  three  ways  in  which  the  occurrence  of 
a  fever  tends  to  produce  insanity.  First,  by  the  direct  stress 
of  the  action  of  the  poison  in  the  blood  on  the  highest 
nervous  arrangements  during  their  working,  which  is 
analogous  to  the  action  of  a  man  throwing  sand  into  the 
bearings  of  a  machine  while  it  is  working.  Second,  by  the 
alteration  of  the  tissue  of  the  brain  by  its  assimilation  of  the 
poisoned  blood  ;  which  is  analogous  to  the  action  of  a  dis- 
honest watchmaker  who  takes  out  some  wheels  of  a  watch 
and  replaces  them  by  wheels  of  inferior  workmanship. 
Third,  by  the  reflection,  in  the  highest  regions  of  the 
nervous  system,  of  the  altered  nutrition  of  the  tissues 
throughout  the  body. 

The  fact  that  the  vast  majority  of  people  who  are  attacked 
by  fever  exhibit  some  derangement,  even  if  only  trifling,  of 
the  action  of  the  higher  nerve  regions,  during  the  time  when 
the  action  of  the  poison  is  most  intense,  shows  how  power- 
ful is  the  action  of  this  direct  stress  ;  and  the  fact  that  the 
vast  majority  of  people  who  suffer  from  fever,  show  no 
permanent  deterioration  of  mind,  shows  the  remarkable 
stability  of  that  condition  of  mobile  equilibrium  which  has 
been  already  referred  to  as  obtaining  throughout  the 
nervous  system.  As  in  other  cases,  so  in  this.  The  escape 
of  the  majority  from  ill  consequences,  together  with  the 
non-escape  of  a  few,  shows  that  the  ordinary  process  of  fever 


248  SANITY   AND   INSANITY. 

alone  is  insufficient  to  produce  insanity.  When  insanity 
follows  fever,  it  is  either  because  the  alteration  of  nutrition 
that  always  takes  place  in  fever  has  in  this  case  lain  with 
unusually  heavy  stress  on  the  higher  regions  of  the  nervous 
system  ;  or  because  the  stress,  arising  from  the  general  altera- 
tion of  nutrition  throughout  the  body,  has  acted,  with 
perhaps  exaggerated  force,  on  a  nervous  system  of  less  than 
normal  stability. 

What  has  been  said  of  fevers  applies  also  to  other  general 
maladies — to  rheumatism,  to  gout,  to  ague,  to  erysipelas, 
syphihs,  and  other  diseases. 

The  last  of  the  indirect  stresses  of  internal  origin  is  that 
which  arises  from  the  altered  innervation  produced  by  some 
bodily  malady  whose  seat  is  local.  It  is  occasionally  found 
that  a  strictly  local  malady — such,  for  instance,  as  an  ulcer 
of  the  intestine,  or  a  flexure  of  the  womb,  a  catarrh  of  the 
stomach  or  of  the  bladder — may  be  accompanied  by  insanity  ; 
and  the  cure  of  the  local  malady  may  be  attended  by 
simultaneous  recovery  from  the  insanity.  In  such  cases  the 
concomitant  variations  of  the  two  sets  of  symptoms — those 
of  the  local  malady,  and  those  of  the  disorder  of  the  highest 
nerve  regions — forbid  us  to  dissociate  them  entirely.  In 
such  cases  as  the  following  there  can  be  no  reasonable  doubt 
as  to  the  existence  of  a  connection  between  the  one  malady 
and  the  other. 

A  patient,  whose  case  is  recorded  by  Schroeder  van  der 
Kolk,  had  catarrh  of  the  bladder,  and  at  the  same  time  had 
violent  nervous  symptoms,  with  hallucinations,  both  visual 
and  auditory.  At  first  the  nature  of  the  bladder  trouble 
was  mistaken,  and  so  long  as  the  mistaken  treatment  con- 
tinued, neither  the  local  nor  the  general  malady  improved. 
At  length,  however,  appropriate  local  treatment  was  adopted, 
the  symptoms  of  catarrh  of  the  bladder  were  quickly  alle- ' 
viated,  and  at  the  same  time  the  patient  awoke  as  out  of  a 
dream.  He  recognized  the  falsity  of  his  previous  notions, 
and    was   practically  well.     After  a  time   he   had  a  slight 


THE    CAUSES    OF    INSANITY.  249 

recurrence  of  the  catarrh,  and  immediately  the  mental 
symptoms  recurred  also  ;  his  hallucinations  returned.  On 
the  cure  of  the  bladder  trouble  the  mental  trouble  perma- 
nently disappeared. 

Niemeyer  relates  that  he  "  treated  a  very  wealthy  man 
for  chronic  gastric  and  intestinal  catarrh,  who,  during  the 
disease,  thought  he  was  near  bankruptcy,  and  left  unfinished 
a  great  building  he  had  begun  because  he  thought  he  had 
not  sufficient  money  to  continue  it.  After  spending  four 
weeks  at  Carlsbad,  his  old  strength  and  feelings  returned, 
he  finished  his  house  with  great  splendour,  and  has  been 
well  ever  since." 

Two  cases  have  been  recorded  by  Dr.  J.  A  Campbell,  and 
I  have  had  two  under  my  own  care,  in  which  local  abdo- 
minal disease  (ulcer  of  the  intestines  in  three  of  the  four 
cases)  was  associated  with  insanity,  and  the  manifestations 
of  the  insanity  had  direct  relation  to  the  bodily  disease.  In 
each  case  the  patient  had  the  delusion  that  his  bowels  were 
entirely  obstructed,  and  that  nothing  ever  passed  through 
him,  and  persisted  in  this  delusion  in  spite  of  daily  evidence 
to  the  contrary.  It  is  very  significant  that  Dr.  Campbell's 
patients  were  brothers,  a  fact  which  speaks  very  strongly  for 
the  existence  of  a  previous  tendency  by  heredity  to  insanity, 
a  tendency  which  was  converted  into  actuality  by  the  stress 
of  the  bodily  malady,  and  received  from  the  latter  its  local 
colour. 


CHAPTER  X. 

THE  CAUSES  OF  INSANITY  {Contiimed\ 

Indirect  Stresses  of  External  Origin. 

This  class  of  indirect  stresses  arise  from  the  action  on  the 
higher  nerve  regions  of  the  circumstances  in  which  the 
individual  is  placed.  It  has  already  been  explained  how 
conduct,  the  aggregate  of  the  movements  of  the  organism 
as  a  whole,  is  actuated  by  the  highest  nerve  regions ;  each 
phase  of  conduct  depending  on  the  action  of  a  special  portion 
of  these  regions.  And  it  has  been  explained  how  conduct  is 
determined,  both  from  moment  to  moment,  and  in  its  longer 
excursions,  by  the  impression  that  is  made  upon  the  organism 
by  circumstances.  The  impressions  that  determine  the 
minor  features  of  conduct  arise  from  limited  portions  of  the 
circumstances,  and  those  that  determine  more  important 
phases  arise  from  larger  and  larger  aggregates  of  circum- 
stances. The  particular  moment  and  place  at  which  it 
becomes  necessary  to  touch  a  horse  with  the  whip  are 
determined  by  the  particular  impressions  made  by  a  limited 
group  of  circumstances — the  pace  and  disposition  of  the 
horse,  the  lie  of  the  ground,  or  the  position  of  surrounding 
objects.  The  choice  of  the  time  and  occasion  of  setting  out 
on  the  journey  is  determined  by  a  larger  group  of  impres- 
sions, made  by  a  larger  group  of  circumstances  :  by  the  need 
of  visiting  a  certain  person,  at  a  certain  distance,  for  a  certain 
purpose.  The  resolution  to  *'  set  up  "  a  carriage  is  deter- 
mined, again,  by  a  larger  group  of  impressions,  proceeding 
from  a  wider  group  of  circumstances :  by  the  recurrence  of 


THE   CAUSES   OF   INSANITY.  251' 

needs  of  travelling  certain  distances  in  certain  times  to 
supply  certain  needs,  by  the  general  state  of  prosperity,  and 
so  forth.  In  each  case  it  is  the  complex  impression  made  by 
an  aggregate  of  various  circumstances  that  determines  the 
conduct  ;  and  the  impressions,  which  are  received  proxi- 
mately by  the  special  sense-organs,  and  are  co-ordinated  and 
combined  in  the  lower  and  intermediate  centres,  produce 
their  special  effect  in  determining  conduct  only  when  they 
impinge  upon,  and  alter  the  disposition  of,  the  highest 
centres. 

It  is  the  normal  function  of  the  impressions  made  by 
circumstances  to  impinge  on  and  to  produce  an  alteration 
in  the  highest  nerve  centres.  It  is  easy  to  understand, 
therefore,  that  if,  from  any  cause,  the  impressions  are 
excessive  in  intensity,  the  alteration  that  they  produce  in 
the  highest  nerve  regions  may  be  excessive.  Normally,  this 
alteration  is  limited  to  the  setting  in  activity  of  centres 
already  organized  or  in  process  of  organization,  and  to 
producing  new  combinations  of  centres,  by  forming  new 
connections  between  them,  in  the  way  indicated  in  the 
opening  chapters.  Speaking  in  terms  of  molecules,  the 
function  of  the  impressions  made  by  circumstances  is  to 
produce  discharge  of  certain  extensive  groups  of  molecules, 
and  re-arrangement  of  certain  other  groups.  Now,  supposing 
that  the  in-going  wave  produced  by  the  impression  is  of 
undue  volume  and  intensity,  it  is  easy  to  understand  that  the 
discharge  of  the  molecules  might  be  continued  to  complete 
disorganization,  and  the  rearrangement  might  be  so  exten- 
sive as  to  result  in  confusion.  Either  of  these  conditions, 
and  a  fortiori  a  combination  of  both,  would  be  sufficient  to 
dissolve  the  organization  of  the  highest  nervous  regions,  an 
organization  which,  as  we  already  know,  is  feebly  compacted, 
unstable,  and  easily  disarranged.  The  highest  nerve  regions, 
whose  function  it  is  to  produce  those  elaborate  and  prolonged 
combinations  of  bodily  movements  in  adaptation  to  circum- 
stances that  we  call  conduct,  are  not  only  of  feeble  stability, 
and  loosely  compacted  organization,  but  they  are,  as  we  have 


252  SANITY   AND   INSANITY. 

seen,  far  less  definite  in  their  limitations  than  the  lower 
centres.  When  a  lowest  centre  is  destroyed,  a  certain  part 
of  the  body,  a  muscle  or  a  limb,  loses  its  function  completely, 
while  adjacent  parts  suffer  little  or  not  at  all.  When  a 
middle  centre  is  destroyed,  a  certain  part  of  the  body,  a 
limb  or  part  of  a  side  of  the  face,  suffers  much,  but  retains 
some  function,  and  the  adjacent  parts — other  limbs  or  the 
rest  of  the  side  of  the  face — suffer  somewhat.  In  the  highest 
centres  the  delimitation  is  still  less  sharply  defined.  When 
one  of  them  is  destroyed,  the  whole  body  suffers  somewhat, 
though  certain  parts  suffer  more  than  other  parts. 

As  an  accompaniment  of  this  absence  of  strict  delimitation 
of  the  function  of  the  highest  nerve  centres  there  is  a  similar 
absence  of  delimitation  of  their  structure.  They  are  not 
rigidly  defined,  but  merge  into  one  another  on  all  their 
confines.  An  excessive  discharge  started  in  a  lower  centre 
does  not  as  a  rule  spread  far.  An  excessive  discharge  started 
in  a  middle  centre  spreads  down  to  its  subordinates  before  it 
begins  to  spread  laterally  to  its  equals  in  rank;  and  hence  we 
find  that  an  epileptiform  seizure,  beginning  in  the  hand, 
spreads  to  the  arm  before  it  begins  to  involve  the  face  or 
leg.  But  an  excessive  discharge,  beginning  in  a  highest 
centre,  has  as  much  tendency  to  spread  laterally  to  its 
coevals,  the  other  highest  centres,  as  to  spread  downwards 
to  its  inferiors.  Hence  we  find  that,  when  a  very  volumi- 
nous impression  is  made  on  the  organism,  a  very  widespread 
wave  of  discharge  spreads  all  over  the  highest  regions,  and 
arouses  in  a  nascent  form  a  vast  complex  of  activities  and  of 
slumbering  forms  of  expression  that  had  previously  been 
registered  there.  Such  a  widespread  wave  of  discharge  is 
accompanied  by  a  mental  state,  a  mental  state  consisting  of 
a  vast  complex  of  indistinct  confused  memories  of  multitu- 
dinous activities  and  impressions  previously  experienced  ; 
and  this  flood  of  vague  memories  is  termed  an  emotion. 

The  physical  accompaniment  of  thought  is,  as  we  already 
know,  the  formation  of  new  connections  between  centres. 
Such  a  process  is  in  its  very  nature  orderly  and  little  prone 


THE    CAUSES   OF    INSANITY.  253 

to  excess.  But  the  physical  accompaniment  or  basis  of  an 
emotion,  which  is  a  diffused  tumultuous  wave  of  general 
discharge  from  many  widespread  regions,  can,  it  is  obvious, 
easily  become  excessive,  and,  when  excessive,  tends  much 
more  strongly,  by  excessive  exhausting  discharge,  to  produce 
disorder,  than  does  the  orderly,  localized  and  gentle  process 
of  forming  connecting  channels  between  one  centre  or  region 
and  another.  Hence  the  impressions  that  tend  to  produce 
disorder  in  the  highest  nerve  regions  are  those  whose  access 
is  attended  by  emotion,  and  those  impressions  which  merely 
are  occasions  for  increase  of  intellectual  activity  are  not  of  a 
dangerous  character.  It  is,  therefore,  in  emotion-producing 
impressions  that  Ave  seek  those  sources  of  stress  that  endanger 
the  stability  of  the  highest  nerve  regions,  and  rank  as  causes 
of  insanity. 

The  inferior  potency  of  this  class  of  indirect  stresses  as 
causes  of  insanity  is  seen  ^in  this  ;  that,  while  the  direct 
stresses  will,  if  sufficiently  potent,  disorder  the  most 
thoroughly  hale  and  stable  nervous  system  sufficiently  to 
produce  manifest  and  unmistakable  insanity  ;  and  while  the 
internally  arising  indirect  stresses,  which  are  harmless  to 
nervous  systems  of  great  stability,  will,  in  those  of  average 
stability,  produce  some  disorder, — the  indirect  stresses  are 
powerless,  even  when  of  great  intensity,  to  produce  insanity 
in  a  person  of  average  nervous  stability.  In  order  to 
occasion  insanity,  the  indirect  stress  must  act  on  a  nervous 
system  which  is  hereditarily  constituted  with  stability  dis- 
tinctly inferior  to  the  normal. 

The  stress  on  the  highest  nerve  regions  will  be  severe  in 
proportion  to  the  volume  and  intensity  of  the  emotion ;  and 
the  character  and  magnitude  of  the  emotion  will  depend  on 
the  character  and  gravity  of  the  circumstances  which  give 
rise  to  it.  Different  sets  of  circumstances  produce  different 
emotions,  of  which  some  are  attended  by  far  greater  stress 
than  others,  but  common  to  them  all  are  the  features  that — 
(i)  The  greater  the  emotion,  the  greater  the  stress  ;  and  (2) 
the  more  sudden  the  emotion,  the  greater  the  stress.     The 


2  54  SANITY   AND   INSANITY. 

emotion  corresponds  in  character  with  the  circumstances 
which  give  rise  to  it,  and  thus  the  two  elements  which 
determine  the  amount  of  stress  which  the  highest  nerve 
regions  have  to  suffer,  are,  the  magnitude  of  the  change  in 
the  circumstances  in  which  the  organism  is  placed,  and  the 
suddenness  with  which  the  change  takes  place. 

Take,  for  instance,  the  stress  of  adversity.  Suppose  that 
a  man  sustains  losses  in  his  business,  in  his  means  of  sub- 
sistence. The  amount  of  stress  that  the  change  in  his 
circumstances  imposes  on  him  depends — (i)  On  the  amount 
of  his  loss.  The  greater  the  loss,  the  greater  his  anxiety,  the 
greater  his  grief,  the  greater  the  body  of  unpleasant  emotion 
that  he  suifers.  But  (2)  the  amount  of  stress  also  depends 
on  the  suddenness  with  which  his  loss  occurs.  If  he  loses, 
say  a  third  of  his  income,  in  small  instalments  spread  over  a 
period  of  several  months  or  years,  the  stress  is  less  intense 
than  if  he  loses  the  same  amount  at  one  blow,  in  a  single 
day.  Similarly,  the  loss  of  a  dear  friend,  after  a  prolonged 
and  lingering  illness,  is  less  severely  felt  than  if  he  had  been 
brought  home  dead  from  an  accident.  The  suddenness  of 
the  change  in  circumstances  is  an  important  element  in 
determining  the  magnitude  of  the  stress.  If  we  remember 
the  characters  of  nervous  action  as  explained  in  the  earlier 
chapters,  we  shall  see  that  susceptibility  to  suddenness  of 
change  is  a  fundamental  character  of  constitution  of  nervous 
tissue.  It  was  there  pointed  out  that  the  application  of  a 
continuous  stimulus  to  a  nerve  produced  no  effect.  It  is 
only  when  the  stimulus  is  applied,  and  when  it  is  removed, 
that  a  current  passes  through  the  nerve.  Or,  when  a 
continuous  stimulus  is  being  applied  to  a  nerve,  if  its 
intensity  be  increased  or  diminished,  then  at  the  moment 
of  alteration  a  current  is  produced  in  the  nerve,  and  the 
magnitude  of  this  current  depends  partly  on  the  amount 
of  the  increase  or  decrease  in  the  intensity  of  the  stimulus, 
and  partly  on  the  rapidity  or  sitddenness  with  which  the 
increase  or  decrease  is  made.  In  other  words,  to  produce 
discharge  in  nerve  tissue,  there  must  be  a  provocation,  and 


THE   CAUSES   OF   INSANITY.  255 

this  provocation  must  be  of  the  nature  of  a  change  in  the 
conditions  to  which  the  tissue  is  subjected.  The  amount  of 
the  discharge  is  proportionate  to  the  magnitude  of  the 
change  which  produces  it,  and  m  the  magnitude  of  a  change 
there  are  two  elements.  One  element  is  the  difference 
between  the  state  from  which  and  the  state  to  which  the 
change  is  made.  The  greater  this  difference,  the  greater 
the  change.  The  other  element  is  the  rapidity  or  sudden- 
ness with  which  the  change  is  made.  The  more  rapid  the 
transition  from  the  one  state  to  the  other,  the  greater  the 
change.  When  a  nerve  is  gradually  warmed,  by  warming 
the  glass  plate  on  which  it  lies,  no  contractions,  or  only  a 
few  trifling  contractions,  take  place  in  the  muscle  to  which 
the  nerve  is  supplied.  When  the  same  nerve  is  rapidly 
warmed  to  the  same  extent,  by  placing  a  rod  of  hot  metal 
upon  it,  a  vigorous  contraction  of  the  muscle  at  once  occurs. 
The  amount  of  change  in  the  nerve  is  the  same  in  the  two 
cases,  but  in  the  one  case  the  change  is  made  slowly  and  the 
result  is  small,  and  in  the  other  the  change  is  made  suddenly 
and  the  result  is  great.  V/hat  is  true  of  this  very  simple 
case  of  nerve  action  is  true  of  more  complicated,  and  of  all 
cases.  The  gradual  rise  in  prosperity  by  a  lifetime  of  toil 
and  prudence  is  productive  of  no  emotional  disturbance. 
But  if  the  same  prosperity  is  attained  suddenly,  by  drawing 
a  prize  in  a  lottery  or  receiving  an  unexpected  legacy,  the 
emotion  aroused  is  great,  and  may,  in  an  unstable  nervous 
system,  be  accompanied  by  disorder.  On  the  other  hand,  if 
the  legacy  comes  to  a  man  who  is  already  wealthy,  the  change 
is  not  so  great  as  if  it  comes  to  one  who  is  living  in  penury  ; 
and,  correspondingly,  it  is  less  liable  to  produce  disturbance 
in  the  former  case  than  in  the  latter.  The  two  elements  in 
the  change,  the  amount  and  the  suddenness,  have  to  be 
estimated  and  allowed  for  in  every  case  in  which  indirect 
stress  is  produced  by  the  action  upon  a  person  of  his 
circumstances.  Bearing  this  in  mind,  we  may  go  on  to 
consider  the  nature  of  the  circumstances  whose  changes  may 
be  productive  of  stress. 


256  SANITY   AND   INSANITY. 

The  entire  aggregate  of  circumstances  in  which  a  human 
being  exists  falls  naturally  into  six  groups,  as  has  been  ex- 
plained elsewhere,^  and  in  each  group  circumstances  may 
occur  of  such  a  nature  as  to  give  rise  to  disordering  stresses 
upon  the  higher  nerve  regions  of  the  organism  that  is  placed 
in  them. 

The  first  group  of  circumstances  are  those  constituting 
the  physical  environment,  that  is  to  say,  those  which  directly 
affect  the  bodily  health.  Such  circumstances  are  the  climate 
and  soil,  the  quality  of  the  air,  the  nature  of  the  food  and 
drink,  the  dryness  or  dampness  of  the  dwelling,  the  whole- 
someness  or  unwholesomeness  of  the  occupation,  and  cir- 
cumstances of  a  like  nature.  With  respect  to  the  circum- 
stances of  this  group,  it  is  evident  that  they  are,  with  one 
exception,  not  of  a  character  to  give  rise  to  intense  stresses 
of  the  indirect  form.  Malaria  in  the  air,  the  poison  of 
typhoid  in  the  water,  lead  in  the  substances  handled  in 
earning  the  livelihood,  may  each  of  them  be  sources  of 
stress,  but  the  stresses  so  arising  are  of  direct  application, 
and  act,  by  their  presence  in  the  blood,  directly  upon  the 
nerve  elements  in  the  way  already  indicated. 

The  exceptional  case,  in  which  circumstances  belonging 
to  the  physical  environment  do  give  rise  to  indirect  stress, 
arise  when  the  circumstances  are  such  as  to  place,  or  to 
appear  to  place,  the  individual  in  bodily  danger.  Under 
such  circumstances  there  arises  the  powerful  emotion  of 
fear  ;  and  if  the  circumstances  arise  suddenly,  so  as  to  add 
the  nnportant  element  of  suddenness  to  the  gravity  of  the 
change,  then  the  emotion  aroused  is  one  of  fright,  and  is 
attended  by  a  stress  of  exceptional  severity. 

So  prominent  a  position  is,  rightly  or  wrongly,  assigned  to 
fright  in  the  causation  of  nervous  maladies,  that  it  will  be 
advisable  to  examine  with  some  care  the  nature  of  the  stress 
that  is  connected  with  it. 

In  the  first  place,  it  is  necessary  to  bear  in  mind  that 
when  nervous  maladies  follow  a  shock  of  fright,  the  fright 
'  "  The  Nervous  System  and  the  Mind,"  p.  152. 


THE  causp:s  of  insanity.  257 

itself  is  not  the  cause  of  the  malady.  Fright  is  a  mental 
state,  an  emotion  of  considerable  volume  and  of  great 
intensity  ;  and  being  a  mental  state,  it  cannot,  as  has  been 
already  so  fully  explained,  have  a  material  origin  or  produce 
material  effects.  It  has,  however,  a  material  accompani- 
ment, and  one  of  great  importance.  When  a  shock  of 
fright  disturbs  the  mind,  a  violent  and  widespread  mole- 
cular commotion  disturbs  the  working  of  the  higher  nerve 
regions.  What  occurs  is  this  :  In  the  long  history  of  our 
ancestry,  innumerable  occasions  have  occurred  on  which 
the  then  existing  representative  of  the  race  has  been  exposed 
to  danger.  On  each  such  occasion  a  strenuous  effort  of 
some  kind  has  been  made  to  escape  from,  or  to  avert,  the 
danger.  Sometimes  the  danger  has  been  of  one  form  and 
sometimes  of  another  ;  and  the  nature  and  direction  of  the 
effort  have  varied  with  the  form  of  danger  ;  but  common  to  all 
such  occasions  have  been  an  impression  made  by  dangerous 
circumstances,  and  a  strenuous  effort  made  to  avert  or 
escape  the  danger.  According  to  the  laws  of  nervous  action 
already  explained,  these  occurrences  will  have  left  in  the 
structure  of  the  nervous  system  traces  of  their  past  exist- 
ence ;  and  these  traces,  these  modifications  of  structure,  will 
have  been  inherited,  passed  on  from  generation  to  gene- 
ration, each  generation  adding,  in  partially  organized  form, 
its  own  contribution  to  these  connections  between  impres- 
sions of  danger  and  strenuous  activity  of  some  form.  The 
activities  have  been  different  in  the  different  cases,  but  they 
have  all  been  widespread  activities — activities  involving 
many  muscles  in  many  combinations — and  the  activity  in 
each  case  has  been  of  very  high  intensity.  It  is  this  high 
intensity  of  the  activity  that  insures  the  permanence 
of  the  "  trace  "  left  in  the  nervous  organization  by  the 
event.  We  have  already  seen  that  the  permanence  of  a 
nervous  connection  depends  in  part  on  the  intensity  of 
the  original  process  of  forming  the  connection,  and  in 
part  on  the  number  of  times  that  the  connection  has 
been    traversed.      In    the  case  of  high  and    wide    activity 

18 


258  SANITY   AND   INSANITY. 

following  exposure  to  danger,  the  nerve  currents  passing 
from  the  receiving  area  to  the  motor  area  are  in  every  case 
of  high  intensity  ;  and  hence  tend  strongly  to  become 
permanent.  As,  however,  occasions  of  imminent  danger 
are  not,  on  the  whole,  very  common  events  in  the  life  of  any 
one  individual,  the  channels  so  formed  will  not  be  often 
traversed,  and  therefore  will  not  retain  a  high  degree  of 
permeability,  although  from  the  intensity  of  the  pressure 
under  which  they  were  originally  formed,  they  will  remain 
slightly  permeable.  Traces,  vestiges  of  their  existence,  will 
remain.  The  general  result  will  be  that  from  the  area  of 
grey  matter,  at  which  are  received  impressions  made  by 
circumstances  of  danger,'  there  will  radiate  very  numerous 
channels  of  very  slight  permeability,  over  virtually  the 
whole  motor  area  of  the  cortex.  When  circumstances  of 
danger  suddenly  present  themselves,  this  receiving  area  is 
suddenly  started  into  intense  activity.  It  discharges  in- 
tensely, and  the  discharge  spreads  as  it  best  can,  in  the 
directions  in  which  resistance  is  least  ;  that  is  to  say,  it  forces 
itself  simultaneously  through  every  channel  of  which  a 
vestige  remains,  and  arouses  into  nascent  action  a  great 
number  of  different  activities,  all  widespread,  all  tending 
to  move  the  whole  body,  all  involving  many  groups  of 
muscles  in  many  combinations.  Now  it  is  obvious  that 
all  these  movements  cannot  occur  at  once.  The  organism 
cannot  move  simultaneously  in  several  different  directions. 
But  still  all  tend  to  occur  ;  all  begin  to  occur  ;  all  become 
nascent.  Until  they  have,  as  it  were,  fought  it  out  among 
themselves,  and  one  has  risen  into  unquestionable  superiority, 
asserted  itself,  and  become  actual,  there  will  be  an  equal 
tendency  for  many  activities  to  occur  at  once  ;  and  the  effect 
of  this  will  be  a  sudden  bracing  up  of  all  the  muscles 
throughout  the  body.     If  the  impression  of  danger  is  sudden 

'  I  do  not  believe  that  there  is  a  localized  area  at  which  such  impressions 
are  received — a  danger  centre,  as  some  might  term  it — but  for  the  purposes 
of  illustration,  and  to  make  the  explanation  clearer,  it  may  be  supposed  for 
the  moment  to  be  localized. 


THE   CAUSES   OE    INSANITY.  259 

and  intense  ;  if,  for  instance,  it  is  a  loud  crash  near  the  ear  ; 
the  nascent  discharge  of  the  numerous  motor  areas  will  be 
sudden  and  intense  ;  the  bracing  up  of  the  muscles  will  be 
sudden  and  intense  ;  and  there  will  be  a  violent  start  of  the 
whole  body. 

After  a  sudden  and  severe  fright  certain  other  effects  are 
noticed.  The  start  is  followed  by  a  prolonged  expiration,  a 
long  puff  of  breath,  a  "  sigh  of  relief,"  which  indicates  that 
at  the  moment  of  the  start,  a  deep  inspiration  was  made. 
The  breath  was  drawn  in,  and  the  chest  fixed,  as  always 
happens  before  a  strenuous  effort  of  any  kind  is  made. 
Now  the  chest  movements  are  movements  of  fundamental 
character,  and  any  discharge  which  modifies  them  must  be 
not  merely  widespread,  but  must  stir  the  lower  strata  of 
the  nervous  system  also.  Furthermore,  it  is  noticed  that 
after  the  start,  and  after  the  sigh  of  relief  which  follows  it, 
the  whole  surface  of  the  body  breaks  out  into  a  sweat,  which 
is  another  sign  of  the  profoundity  of  the  disturbance  which 
the  nervous  system  suffers.  The  whole  phenomena  of  the 
starting  in  fright,  indicate  that  there  is,  throughout  a  very 
wide  area,  and  to  a  very  great  depth  in  the  nervous  system, 
a  sudden  and  excessive,  if  brief,  discharge. 

Now,  whenever  a  mechanism  is  started  suddenly,  and 
especially  when  it  is  suddenly  started  into  excessive  action, 
it  isliable  to  be  disordered.  A  clumsy  coachman,  starting 
his  horses  with  a  loose  rein,  will  be  apt  to  break  the  traces. 
An  engine  driver  never  starts  his  engine  by  pulling  his  lever 
over  to  the  full  extent,  and  getting  full  steam  on  at  once. 
He  knows  that  if  he  does  so,  he  will  certainly  break  or 
disorder  some  of  the  mechanism.  What  he  does  is  to  start 
gently,  and  gradually  to  increase  the  pressure  as  speed  is 
attained.  It  is  the  same  in  the  nervous  system.  If  the 
nerve  elements  are  to  work  orderly  and  safely,  they  must 
start  into  action  gradually.  If  they  start  suddenly,  and 
especially  if  they  start  suddenly  into  violent  action,  they 
will  be  liable  to  become  disordered.  The  whole  pheno- 
mena of  "a  fright,"  show  that  it  is  a  sudden  "start  "  into 


26o  SANITY    AND    INSANITY. 

violent  action.  Tlie  nervous  system,  throughout  a  very  wide 
area,  and  to  a  very  great  depth,  is  suddenly  started  into  great 
activity;  and  the  shock  of  such  a  start  is  eminently  calculated 
to  produce  disorder.  Hence  we  find  that  many  cases  of 
nervous  disorder  make  their  first  appearance  after  a  fright, 
and  are  doubtless  correctly  attributed  to  the  stress  that 
accompanies  the  fright.  Among  the  disorders  so  produced 
is  insanity,  and  every  year  a  small  proportion,  amounting 
to  about  fifteen  in  every  thousand  of  the  persons  who  become 
insane  in  this  country,  have  their  insanity  ascribed  to  fright 
and  nervous  shock. 

Many  thoroughly  well-authenticated  instances  of  the 
efficacy  of  this  form  of  stress  in  producing  nervous  disorder 
have  been  recorded.  The  cases  adduced  in  a  previous 
chapter  of  the  changes  of  colour  in  the  hair  and  skin  are 
cases  in  point.  The  disorder  showed  itself  indeed  in  dis- 
colouration of  the  skin,  and  greyness  of  the  hair,  but  it  was 
of  course  produced  by  nervous  action.  Gowers  records  the 
case  of  a  girl  who  had  four  attacks  of  chorea,  each  excited 
by  the  shock  attending  a  fright.  Of  epilepsy  he  says  that 
the  most  potent  exciting  causes  are  mental  emotion,  fright, 
excitement,  and  anxiety,  and  the  most  frequent  of  these  is 
fright.  Bucknill  and  Tuke  mention  the  case  of  a  young 
woman  who  was  assaulted  and  violated.  From  that  hour  she 
never  spoke  ;  she  speedily  became  completely  demented,  and 
so  continued  till  her  death.  Dr.  Savage  records  a  case  in 
which  a  fire  in  the  house  was  the  occasion  of  an  attack  of 
acute  mania.  I  am  acquainted  with  a  case  in  which  a  fright 
given  to  a  child  by  a  nurse-maid  in  a  foolish  practical  joke, 
was  folloAved  by  such  a  derangement  in  the  nervous  system 
of  the  child  that  it  stammered  ever  after. 

The  group  of  circumstances  constituting  the  Vital  environ- 
ment is  that  in  which  indirect  stresses  most  frequently 
arise.  In  this  group  are  included  all  those  circumstances 
which  affect  the  livelihood  or  means  of  subsistence.  In 
these  circumstances  are  included  the  nature  of  the  occu- 
pation, the  scarcity  or  abundance  of  employment,  the  rate 


THE    CAUSES   OF    INSANITY.  26 1 

and  kind  of  remuneration,  the  degree  of  dependence  or 
independence,  the  character  of  employers,  of  official  superiors, 
the  tenure  by  which  office  is  held,  the  precariousness  or 
certainty  of  the  means  of  subsistence,  the  state  of  markets, 
the  demand  for  commodities,  the  facilities  for  and  obstacles 
to  commerce,  the  vagaries  of  fashion,  the  amount  of  leisure 
that  the  vital  occupation  leaves,  the  proportion  of  the  total 
energies  that  it  absorbs.  There  are  but  four  elements  in 
this  large  group  of  circumstances  that  are  sources  of  stress 
on  the  higher  nerve  regions.  These  elements  are  (i) 
exhausting  nature  ;  (2)  deficiency  ;  (3)  fluctuation  ;  and  (4) 
precariousness  of  the  means  of  livelihood. 

Means  of  livelihood  are  of  an  exhausting    or   "  trying  " 
character  when  they  absorb   an  undue   proportion  of   the 
total  energies.     In  a  normal  existence  the  process  of  obtain- 
ing a  livelihood  does  not  absorb  the  whole  or  nearly  the 
whole  of  the  energies.     After  the  livelihood  is  gained,  there 
should  remain  a  considerable  residuum  of  leisure  time  and 
spare  energy  for  family  and  social  and  political  activity,  for 
recreative    and    aesthetic   employment.      These    secondary 
fields  of  activity  are  neither  so  extensive  nor  of  so  exhaust- 
ing  a  character  as  the  primary  field    of   livelihood  ;    and 
moreover,  the  very  fact  of  changing  the  field  and  character 
of  the  activity,  is  of  itself  of  the  nature  of  a  rest.     It  brings 
into  play  new   activities,  developes   new  sides  of  the  cha- 
racter, and  allows  a  period  of  rest  and  recuperation  to  those 
activities  which  are  directly  concerned  in  earning  the  liveli- 
hood.    When  the  means  of  livehhood  are  of  so  exigeant  a 
nature  that  they  absorb  the  whole  of  the  energies,  and  leave 
neither  time  nor  energy  for  employment  in  other  ways  ; 
when,  for  instance,  a  man  has  to  work  fourteen,  sixteen,  and 
seventeen  hours  a  day  at  his  occupation,  it  is  evident   that 
his  nature  cannot    develop  itself   in    other    directions.     A 
portion  of  his  activities  Avill  be  exercised  to  exhaustion,  and 
another  portion  will  be  unemployed,  and  will  become  pent 
up,  will  accumulate  under  pressure,  and  will  tend  to  break 
out  in  disorderly  action.     In  this  way,  too  prolonged  hours 


262  SANITY   AND   INSANITY. 

of  work  are  productive  of  stress.  Besides  the  undue  prolong- 
ation of  work,  another  cause  of  stress  exists  in  work  of  unduly 
absorbing  character  ;  work  which  requires  unremitting  care, 
attention,  and  precision.  In  the  daily  occupation  of  the 
vast  majority  of  people,  by  far  the  greater  part  of  the  work 
is  routine  work,  is  work  that  has  become  habitual,  and  that 
can  be  carried  on  correctly  without  great  concentration  of 
the  attention.  The  navvy  in  excavating,  the  labourer  in 
ploughing  and  sowing,  the  coachman  in  driving,  the  cook 
in  concocting  a  dish,  is  doing  over  again,  with  only  slight 
and  infrequent  variations,  that  which  they  have  done  many 
times  before.  Now  to  do  a  thing  which  has  been  done 
many  times  before,  involves  but  little  strain  upon  the  atten- 
tion. Attention  becomes  necessary  only  when  variations 
have  to  be  made,  when  new  proceedings  have  to  be  executed, 
when  something  unfamiliar  has  to  be  done.  In  the  same 
way,  a  doctor  in  seeing  his  patients,  sees  in  the  majority 
of  cases,  combinations  of  symptoms  which  he  has  witnessed 
in  the  main  many  times  before,  and  the  ways  of  treating 
them  recur  to  him  with  little  effort.  Only  occasionally 
does  he  meet  with  a  case  displaying  unfamiliar  symptoms 
or  unfamiliar  combinations  of  symptoms  ;  and  only  in  such 
cases  does  a  special  mental  effort  become  necessary.  The 
same  is  the  case  with  the  lawyer.  The  great  majority  of  his 
work  is  routine  work  ;  the  names  and  the  other  details  of 
the  cases  differ,  but  the  main  features  of  the  case  that  he  has 
noAv  to  deal  with  resemble  the  main  features  of  cases  that 
he  has  dealt  with  before  ;  the  ways  of  dealing  with  them 
arise  in  his  mind  without  effort  and  without  strain.  In 
every  business  the  main  part  consists  of  routine  work,  of 
operations  which  have  become  habitual,  and  are  attended 
with  but  little  activity  of  the  very  highest  nerve  regions. 
Now  it  is  in  activity  of  these  very  highest  nerve  regions  that 
stress  arises.  It  is  easy  to  understand  that  so  long  as  the 
activity  that  is  going  on  is  mere  habitual  activity — is  activity 
proceeding  in  well-worn,  well-organized  channels,  there  will 
be  little  tendency  for  the  process  to  become  disorderly.    But 


THE   CAUSES   OF   INSANITY.  263 

Avhen  the  activity  consists  in  forcing  new  channels  in  directions 
hitherto  untraversed,  the  process  is   in  its   nature  a  more 
exhausting  one.     It  absorbs  and  uses  up  a  greater  quantity 
of  energy  to  force  a  new  channel  than  to  traverse  an  old 
one,  and  hence  activity  on  the  higher  levels  tends  sooner  to 
exhaustion,   and  to  the  pathological  effects   of  exhaustion, 
than  activity  on  lower  levels.     Moreover,  when  activity  on 
the  higher  levels  is  unduly  sustained,  the  exhaustion   may 
easily  become  extreme.     Hence,  in  any  occupation  in  which 
routine  work  is  reduced  to  a  minimum,  and  continuous  close 
attention  becomes  necessary,  the  stress  on  the  highest  nerve 
regions  is  great,  and  the  possibilities  of  disorder  are  increased. 
Hence  it  is  found,  that  while  overwork  is  not  a  fertile  cause 
of  insanity,  yet  in  cases  in  which  the  work  has  been  of  a 
nature  to  require  a  close  and  prolonged  application  of  atten- 
tion, the  stress  so  produced  is  occasionally  sufficient  to  pro- 
duce disorder  ;  so  that  a  prolonged  process  of  preparation  for 
examination  is  the  most  fertile  source  of  disorder  under  the 
heading  of  overwork.     If  we  can  find  tAvo  bodies  of  men  who 
are  subjected  as  far  as  possible  to  the  same  conditions  in  other 
respects,  but  whose  work  differs  in  respect  of  the  amount  of 
continuous  and  close  attention  that  it  demands  ;  we  ought  to 
find,   if  the  foregoing  discussion  is    valid,   that  that    body 
whose    work    demands    most    attention,    and    is    therefore 
attended  by  most  stress,  should  furnish  the  largest  number 
of  cases  of  insanity.     Such  an  instance  is  furnished  ready  to 
our  hand  by  railway  servants.     Serving  the  same  masters, 
living  in  the  same  mental  atmosphere,  subject  to  the  same 
conditions  with  regard  to  the  security,  &c.,  of  their  livelihood, 
all  classes  of  railway  servants  are  circumstanced  pretty  much 
alike,  with  the  exception  of  the  drivers  and  stokers,  who, 
circumstanced  alike  in  other  particulars,   are   subjected  to 
far  greater  stress  from  the  prolonged,  continuous,  close,  and 
vigilant  attention  which  their  work  necessitates.     Among 
all  other  classes  of  railway  servants,  cases  of  insanity  occur 
at  the  rate  of  about  5*5   in  10,000  per  annum.     But  out  of 
every  10,000  of  drivers  and  stokers,  no  fewer  than  seventeen, 


264  SANITY   AND   INSANITY, 

or  more  than  treble  the  proportionate  number,  annually 
become  insane. 

It  is  not  contended  that  attentive  and  intelligent  work  is 
necessarily  a  cause  of  insanity,  even  when  pushed  to  a 
degree  which  absorbs  a  very  large  proportion  of  the  time 
and  energies.  The  contention  is  that,  among  the  causes  of 
stress  that  will  provoke  an  outbreak  of  insanity  in  a  person 
hereditarily  predisposed  to  become  insane,  is  that  of  a  too 
prolonged,  too  continuous  demand  for  close  and  vigilant 
attention.  It  must  be  admitted  that  the  stress  of  over- work 
is  not  a  common  occasion  of  insanity. 

The  amount  of  labour,  the  number  of  hours  of  continuous 
exertion,  of  which  so  very  many  persons  prove  themselves 
capable  under  necessity,  is  very  great  and  surprising.  The 
researches  of  the  Sweating  Committee  have  shown  that  it  is 
frequent  for  people  to  work  for  sixteen  and  seventeen  hours 
a  day,  with  the  closest  application,  for  six  and  even  seven 
days  a  week,  and,  among  the  people  who  do  so,  insanity  is 
not  especially  common.  But  then  it  is  to  be  remembered 
that  the  work  these  people  do  is  of  the  merest  routine  and 
mechanical  character  ;  it  is  sewing  button-holes,  or  making 
shirts  or  trousers.  It  is  done  to  a  very  large  extent  auto- 
matically, and  docs  not  involve  a  strain  on  the  highest  nerv^e 
regions. 

Then,  again,  it  is  remarkable  how  men,  who  are  naturally 
hard-worked  in  their  own  proper  professions,  will  undertake 
a  large  amount  of  gratuitous  and  unnecessary  labour  in 
addition  to  that  which  they  are  obliged  to  do.  After 
spending  a  whole  day  in  their  office  or  chambers,  they  will 
pass  the  evening  in  political  or  charitable  or  artistic  work, 
and  will  perhaps  rise  early  in  the  morning  to  take  a  ride  or 
a  swim  before  going  to  business.  And  these  are  not  the 
people  who  show  signs  of  stress.  They  are  the  most  healthy, 
vigorous,  and  happy  of  men.  They  are  happy  because  they 
are  healthy  and  vigorous  ;  and  it  is  because  they  have  in- 
herited such  splendid  constitutions,  because  they  have  within 
them  so   great  a  store  of  energy,  that   they  seek   so  many 


THE   CAUSES   OF    INSANITY.  26" 

outlets  for  this  energy,  and  can  maintain  so  many  diflferent 
forms  of  activity  concurrently.  Exertion  which  is  under- 
taken in  order  to  satisfy  and  expend  the  buoyant  spontaneity 
of  a  man's  nature  is  never  harmful.  It  is  only  when  the 
energies  are  drained  by  exertions  that  are  made,  not  spon- 
taneously, but  in  answer  to  urgent  and  repeated  demands — 
demands  that  may  not  be  refused — -that  the  reserve  store  of 
energy  is  lowered  to  a  dangerous  extent,  and  stress  arises. 
It  is  to  be  noticed,  also,  that  spontaneous  exertion  is  always 
varied  in  form.  It  is  now  mental,  now  athletic.  The  objects 
of  pursuit  are  many  and  various,  the  activities  displayed  in 
each  pursuit  are  different,  and  while  one  is  active  the 
remainder  are  resting.  But  the  exertion  that  is  made  in 
response  to  an  imperative  demand  is,  as  a  rule,  a  continuous 
exertion  of  the  same  class  of  activities,  and  is  therefore  more 
exhausting. 

The  stress  arising  from  over-exertion  is  unquestionably  of 
rare  occurrence.  In  order  to  be  productive  of  stress,  the 
attention  must  be  occupied  with  a  closeness  and  vigilance, 
and  over  a  period  of  time,  such  as  are  not  often  called  for 
even  in  exacting  occupations.  I  fully  agree  with  Dr.  Wilks 
that  "  if  both  sexes  be  taken,  the  opposite  is  nearer  the 
truth  ;  and  that  more  persons  are  suffering  from  idleness 
than  from  over-work.  .  .  .  The  persons  who  apply  to  the 
doctor  are  not  the  Prime  Minister,  the  bishops,  judges,  and 
hard-working  professional  men,  but  merchants  and  stock- 
brokers retired  from  business.  Government  clerks  who  work 
from  ten  to  four,  women  whose  domestic  duties  and  bad 
servants  are  driving  them  to  the  grave,  young  ladies  whose 
visits  to  the  village  school,  or  Sunday  performance  on  the 
organ,  is  undermining  their  health,  and  so  on."  There  is  a 
common  saying  that  "  hard  work  never  hurt  any  one,"  and, 
like  most  common  sayings,  it  expresses  one  half  of  a  truth. 
Mere  laboriousness  of  occupation  probably  never  did  hurt 
any  one,  provided  that  it  was  accompanied  with  a  sufficiency 
of  food  and  of  sleep.  When,  however,  to  laboriousness  of 
occupation  is  added  a  demand  for  close  and  vigilant  attention. 


266  SANITY    AND    INSANITY. 

the  occasion  is  much  more  exhausting  ;  and  exertion  upon 
this  higher  level  of  the  nervous  system  is  apt  to  be  accom- 
panied by  sleeplessness.  The  activity  evoked  in  the  highest 
nerve  regions  is  so  great  and  so  widespread,  that  it  is  with 
difficulty,  and  only  after  prolonged  absence  of  stimulus,  that 
it  subsides  into  the  quiescent  state  that  obtains  during  sleep, 
and  that,  in  fact,  constitutes  sleep. 

2.  The  scantiness  or  abundance  of  the  means  of  livelihood 
has  little  influence  per  se  in  inducing  indirect  stress  on  the 
higher  nerve  regions.  The  possessors  of  great  wealth  are, 
indeed,  prone  to  dilate  upon  the  cares  and  responsibilities 
that  great  wealth  brings  with  it,  but  that  these  cares  and  re- 
sponsibilities ever  attain  such  proportions  as  to  constitute  a 
source  of  stress  there  is  no  evidence  to  show.  Undoubtedly 
cases  have  occurred  in  Avhich  a  sudden  accession  to  great 
wealth  has  been  the  occasion  of  an  outbreak  of  insanity  ;  but 
in  such  cases  it  is  the  gravity  of  the  change^  and  not  the 
affluence  of  the  circumstances,  that  has  brought  about  the 
result.  Such  cases  fall  to  be  considered  under  the  next 
heading. 

Neither  does  the  opposite  condition  of  scantiness  of  the 
means  of  livelihood  appear  to  be  per  se  a  source  of  such 
severe  stress  as  to  be  an  important  factor  in  the  production 
of  insanity.  It  is  not  found  that  insanity  is  especially  pre- 
valent among  the  very  poor,  although  doubtless  the  standard 
of  intelligence  among  that  class  is  lower  than  in  the  rest  of 
the  community.  The  poverty  is,  however,  more  a  result  than 
a  cause  of  the  lack  of  intelligence.  When  means  of  sub- 
sistence fall  so  low  as  to  verge  on  starvation,  then  the  higher 
nerve  regions  get  badly  nourished,  and  the  signs  of  aliena- 
tion resulting  from  the  direct  stress  of  imperfect  nutrition 
begin  to  show  themselves  ;  but  short  of  actual  starvation,  the 
struggle  of  penury  against  necessity,  urgent  as  it  often 
is,  does  not  appear  to  be  attended  by  specially  severe  stress 
of  the  kind  we  are  considering.  When  the  stress  arising 
from  "  adverse  circumstances  "  is  a  factor  in  the  production 
of  insanity,  it  is  always  found  that  the  adverse  circumstances 


THE   CAUSES   OF   INSANITY.  267 

have  not  been  the  normal  state.  In  such  cases  there  has 
always  been  a  fall  from  a  more  prosperous  to  a  more  adverse 
condition,  and  the  stress  is  more  properly  ascribable  to  the 
change  in  circumstances  than  to  the  poverty  itself. 

3.  In  the  case  of  worldly  prosperity,  as  in  every  other  agent 
that  affects  the  nervous  system,  it  is  this  element  of  change 
that  is  the  most  important  factor  in  the  production  of  stress  ; 
and,  as  in  other  cases,  the  gravity  of  the  stress  is  measured 
by  the  magnitude  and  the  suddenness  of  the  change. 

Stress  is  least  urgent  when  the  change  is  from  a  less 
prosperous  to  a  more  prosperous  condition  ;  and  to  produce 
ill  effect,  a  change  in  this  direction  must  be  of  great  gravity — 
must  be  both  sudden  and  of  great  magnitude.  That  such  a 
stress,  however  grave,  will  not  produce  disorder  unless  it  act 
upon  a  nervous  system  of  undue  instability,  is  of  course 
understood.  When  all  the  conditions  are  favourable  for  its 
occurrence,  disorder  does  occasionally  occur  upon  this  pro- 
vocation ;  and  cases  are  on  record  in  which  a  sudden  accession 
to  fortune,  by  a  person  previously  in  poor  circumstances,  has 
been  immediately  followed  by  an  outbreak  of  insanity.  In 
one  instance  three  members  of  the  same  family — a  mother 
and  two  daughters — became  insane  upon  a  sudden  accession 
to  fortune  :  two  of  them  upon  being  informed  of  the  change 
in  their  circumstances. 

The  reverse  change — from  a  more  to  a  less  prosperous 
condition — is  a  more  fertile  occasion  of  insanity,  and  this  no 
doubt  for  two  reasons  :  first,  because  the  change  in  this 
direction  is  much  more  common  than  in  the  other  ;  and, 
second,  because  in  this  change  the  stress  is  naturally  so  much 
greater.  As  in  the  previous  cases,  the  gravity  of  the  stress 
will  depend  in  part  on  the  magnitude  of  the  change,  on  the 
amount  of  the  vicissitude  of  fortune  that  is  suffered,  and  in 
part  on  the  suddenness  with  which  this  change  occurs. 

A  person  who  lives  always  on  the  verge  of  penury  ;  whose 
means  of  subsistence  suffice,  at  the  best  of  times,  to  procure 
for  him  only  the  bare  necessaries  of  life  ;  who  seldom^  enjoys 
the    satisfaction    of   having    quite    enough    to    eat  ;  whose 


268  SANITY    AND   INSANITY. 

clothing  in  winter  is  seldom  substantial  enough  to  be  a  full 
protection  against  the  weather  ;  whose  dwelling  is  at  the  best 
of  times  destitute  of  all  comforts,  and  of  many  things  which 
are  regarded  by  the  majority  of  people  as  necessaries  ; — such 
a  person  will  suffer  less  stress  from  a  complete  withdrawal  of 
his  scanty  means  of  subsistence,  than  will  another  person  who 
is  accustomed  to  live  in  the  lap  of  luxury,  and  who,  from 
loss  of  the  greater  part  of  his  fortune,  is  compelled  to  remove 
from  a  lordly  mansion  to  a  cottage  of  six  rooms.  Although 
the  condition  of  the  first  man,  who  is  reduced  to  sleeping 
under  a  haystack,  and  who  knows  not,  when  he  awakes  in 
the  morning,  whether  or  no  he  will  taste  food  that  day,  is 
absolutely  worse  than  that  of  the  second,  who  has  a  neatly 
furnished  cottage,  and  enough  saved  out  of  the  wreck  of  his 
fortune  to  provide  him  with  a  living  for  the  rest  of  his  life  ; 
yet  the  amount  of  vicissitude  experienced  by  the  first  is  not 
so  great  as  that  experienced  by  the  second.  He  has  landed 
at  a  lower  depth,  it  is  true,  but  he  has  not  fallen  so  far.  The 
change  from  penury  to  destitution  is  not  so  great  as  that 
from  luxury  to  poverty  ;  and  the  stress  that  is  experienced 
in  the  first  case  is  less  severe  than  that  experienced  in  the 
second. 

With  regard  to  the  suddenness  with  which  adversity 
comes,  it  is  unnecessary  to  repeat  what  has  been  already 
said  on  that  subject.  It  is  obvious  that  the  sudden  and  un- 
expected loss  of  fortune  is  productive  of  much  more  intense 
stress  than  a  loss  going  on  by  driblets,  long  foreseen,  and 
extended  over  many  years.  That  the  suddenness  with 
which  a  calamity  occurs  increases  the  gravity  of  the  stress 
that  it  occasions,  is  recognized  in  the  prevalent  practice  of 
"  breaking  "  ill  news.  The  intelligence  of  disaster  is  com- 
municated to  the  person  whom  it  most  affects,  not  at  once  and 
in  the  mass,  but  gradually  and  by  instalments.  In  this  way 
it  is  considered,  and  rightly  considered,  that  the  force  of  the 
stress  is  dissipated,  broken,  and  diminished. 

It  is  remarkable  that  although  a  single  vicissitude  of 
fortune  is  attended  by  so  great  a  stress  that   insanity  not 


THE    CAUSES    OK    INSANITY.  269 

very  infrequently  follows,  yet  repeated  vicissitudes  are  less 
dangerous,  and  the  reason  seems  to  be  that  the  first  occasion 
is  the  occasion  of  the  greatest  shock — of  the  greatest  change 
— and  that  subsequent  vicissitudes  act  upon  an  organism 
which  has  become  to  some  extent  habituated  to  them — to 
whom  they  are,  therefore,  changes  of  less  novelty  and  less 
gravity,  and  so  are  attended  by  diminished  stress. 

4.  If  actual  vicissitudes  of  fortune  are  attended  by  in- 
tense stress  upon  the  higher  nerve  regions,  impending 
vicissitudes  are  attended  by  a  stress  which,  if  less  intense,  is 
more  enduring  :  and  especially  dangerous  is  the  long-con- 
tinued and  varying  stress  which  attends  precarioiisness  of 
the  means  of  livelihood.  In  this  case,  again,  the  stress  is  less 
upon  those  who  live  upon  the  margin  of  the  self-supporting 
community,  who  for  part  of  the  year  are  able  to  earn  their 
own  subsistence,  and  for  another  part  regularly  seek  the 
shelter  of  the  workhouse.  In  such  cases,  indeed,  the  means 
of  living  are  not  really  precarious,  for  they  are  sure  all  the 
year  round  of  some  subsistence,  and  of  subsistence  which  does 
not  vary  much  in  amplitude  whether  they  are  inside  or  out- 
side the  "  House."  The  intensest  stress  lies  upon  those  who 
live  in  comfortable,  or,  it  may  be,  luxurious  circumstances, 
but  Avho  cannot  calculate  with  certainty  on  the  continu- 
ance from  day  to  day  of  their  standard  of  living.  To  such 
people  the  failure  of  the  means  of  subsistence  means  much 
more  than  to  the  other  class.  It  means  not  merely  a  far 
greater  change  in  the  mode  of  living,  but  it  means  more  or 
less  disgrace  ;  it  means  a  fall  in  the  estimation  of  their 
fellows  ;  it  means  the  loss,  not  only  of  livelihood,  but  of 
most  of  the  things  which  make  life  worth  living.  Those 
who  live  in  comfortable  circumstances,  but  whose  living  is 
precarious,  live  under  a  perpetual  load  of  care.  They  are 
subject  to  the  incessant  stress  of  recurring  anxieties,  and 
such  a  stress  has  all  the  evil  quality  of  that  already  dealt 
with  as  arising  from  too  close  and  too  prolonged  attention, 
together  with  an  additional  element  of  stress  in  the  intrinsi-^ 
cally  lowering,  depressing  influence  of  the  anxiety. 


270  SANITY   AND   INSANITY. 

There  is  one  other  circumstance,  connected  with  the 
means  of  HveHhood,  that  is  apt  to  produce  stress  in  those 
who  are  subjected  to  its  influence  ;  and  that  is  the  sudden 
cessation  of  work  by  one  who  has  been  for  many  years 
accustomed  to  a  uniform  course  of  toil.  The  disappoint- 
ment that  is  in  store  for  those  who  have  been  looking 
forward,  during  a  lifetime  of  toil,  to  the  period  of  golden 
leisure  that  they  shall  enjoy  in  the  evening  of  their  days, 
has  become  a  stock  subject  for  the  moralist  for  many 
generations.  All  have  heard  of  the  soap-boiler,  mentioned 
by  Dr.  Johnson,  who,  after  selling  his  business,  begged  of 
his  successor  to  allow  him  to  come  up  on  melting-days  and 
witness  the  operation  ;  and  the  anecdote  illustrates  a  state 
of  things  which  is  extremely  common.  A  man  who  has  all 
his  life  been  in  active  employment,  who  has  not  only 
always  had  abundant  outlet  for  all  his  activities,  but  who 
has,  by  long  habit,  so  modified,  and  moulded,  and  trained  his 
nervous  system,  that  a  certain  amount  of  activity  is  forth- 
coming every  day,  suddenly  relinquishes  his  employment, 
and  stops  up  the  channels  by  which  these  habitually  accu- 
mulating energies  were  habitually  expended.  What  must 
happen  is  clear.  The  activities  will  not  suddenly  cease. 
The  man  may  voluntarily  relinquish  the  habitual  modes  of 
employing  himself,  but  he  cannot,  at  a  few  days'  notice,  so 
modify  his  nervous  system  as  to  cause  it  to  abandon  habits 
which  have  been  the  groAVth  of  a  lifetime.  The  activities 
still  continue  to  be  felt.  The  energies  still  continue  to  be 
generated  ;  but,  cut  off  from  their  normal  and  habitual  mode 
of  expression,  they  accumulate  ;  they  become  pent  up  ;  and, 
unless  outlet  is  found  for  them,  they  will  infallibly  produce 
disorder.  Hence  we  find  that  when  a  man  in  the  evening 
of  life,  or  about  the  time  that  was  considered  by  the  ancients 
his  grand  climacteric,  retires  from  his  business,  he  is  subject 
to  stress  ;  and  if  by  this  time  his  energies  have  not  much 
diminished,  but  are  still  very  active  ;  and  if  he  has  no 
alternative  occupations  in  which  he  can  find  outlet  for  his 
unemployed  activities  ;    this  stress  is  extremely   likely   to 


THE   CAUSES   OF    INSANITY.  27 1 

produce  disorder.  Within  six  months  I  have  been  con- 
sulted about  five  gentlemen,  all  of  whom  were  becoming, 
or  were,  insane  from  this  cause.  All  of  them  were  men 
of  great  bodily  and  mental  activity,  all  about  the  same 
age,  all  had  recently  retired  from  active  business,  and 
here  is  the  significant  fact — all  of  them  were  destitute  of 
mental  resources.  Not  one  of  them  ever  opened  a  book  ; 
not  one  of  them  had  a  hobby  ;  not  one  of  them  cared  for 
music  or  any  form  of  recreation,  with  the  sole  exception  of 
one  Avho  occasionally  played  golf,  and  one  who  occasionally 
played  chess.  Not  one  of  them  took  any  active  part  in 
social,  municipal,  or  political  Hfe.  It  is  remarkable  that  the 
cases  of  insanity  arising  from  this  cause  usually  exhibit  the 
same  symptoms.  In  all  the  above  five  cases  the  patients 
were  very  wealthy  men,  and  each  one,  upon  relinquishing 
his  business,  sank  into  melancholia,  and  cherished  the  belief 
that  he  was  miserably  poor.  One  tried  to  take  his  own  life 
with  the  intention  of  relieving  his  family  of  the  burden  of 
supporting  him  ;  another  entered  his  sumptuous  carriage 
and  told  his  coachman  to  drive  to  the  workhouse,  saying  it 
was  the  only  place  he  himself  was  fit  for.  It  is  cases  of  this 
class  which  show  perhaps  most  clearly  that  the  seat  of  the 
disorder  is  in  the  process  of  adjusting  themselves  to  their 
surroundings. 

The  next  group  of  circumstances  from  whence  stress  may 
arise,  is  that  constituting  the  Family  environment  ;  which 
includes  the  circumstances  as  to  parentage,  marriage,  off- 
spring and  other  relatives  ;  the  degree  of  dependence  or  in- 
dependence existing  among  them  ;  the  help  or  hindrance  that 
they  afford  to  the  individual  in  his  struggle  for  life ;  and  the 
customs  and  laws  which  regulate  his  dealings  with  them. 
The  circumstances  in  the  Family  environment  that  may  be 
productive  of  stress  are  those  which  arouse  emotion,  and  the 
stress  that  they  produce  is  severe,  according  as  the  emotion 
aroused  is  intense,  is  voluminous,  and  is  long  continued.  It 
will  be  convenient  to  consider  the  stresses  in  the  order  of  the 
relationship  of  the  persons  whose  conduct  gives  rise  to  them* 


272  SANITY   AND    INSANITY, 

The  conduct  of  parents  towards  their  children  is  not  often 
conducive  to  insanity  in  the  children,  and  this  is  probably 
because  in  childhood,  when  the  relation  of  the  parents  is 
most  important,  and  their  influence  predominant,  acquired 
insanity  is  extremely  rare  ;  while  in  adult  life,  when  insanity 
is  more  readily  acquired,  the  influence  of  the  parents  as  pro- 
ducers of  emotion  is  not  very  powerful.  There  is,  however, 
one  case  in  which  this  influence  is  directly  productive  of 
insanity,  and  that  is  the  case  of  an  hysterical  girl  with 
a  foolish,  weak,  indulgent,  fussy,  anxious  mother.  The 
mothers  of  hysterical  girls  are  often  of  this  description,  and 
their  influence  upon  their  children  is  noxious  in  a  high 
degree.  The  girl  whose  salvation  depends  upon  being 
"  taken  out  of  herself  ;  "  upon  having  her  attention  with- 
drawn from  her  own  coensesthesis,  and  concentrated  upon 
externals  ;  upon  being  induced  and  compelled  to  interest 
herself,  not  in  her  own  feelings,  but  in  what  is  going  on  in 
the  world  around  her  ;  is  taken  in  hand  by  an  over-solicitous 
mother  ;  put  to  bed  ;  shut  off  as  far  as  possible  from  com- 
merce with  varied  scenes  and  external  interests  ;  and  taught 
by  continual  inquiry  into  "  how  she  feels,"  by  continual 
expatiation  to  friends  and  visitors  upon  her  delicacy  and 
precarious  condition,  to  concentrate  and  intensify  the  interest 
that  she  is  naturally  predisposed  to  take  in  her  own  sensa- 
tions ;  and  is  thus  urged  and  worried  into  a  condition  which 
always  partakes  of  the  nature  of  insanity,  and  which 
occasionally  culminates  in  a  definite  outbreak  of  mania. 

The  relationship  towards  brothers  and  sisters  does  not 
include  many  occasions  of  stress.  The  chief  occasion  so 
arising  is  when  one  or  two  or  several  brothers  or  sisters  of 
an  individual  are  already  afflicted  with  insanity.  In  such 
cases  the  members  of  thefamily  who  still  remain  sane  are 
subjected  to  a  very  definite  stress  of  considerable  intensity. 
The  fear  of  following  in  the  footsteps  of  their  relatives,  and 
of  themselves  becoming  insane,  is  so  urgent,  and  is  attended 
by  so  great  a  stress,  as  sometimes  of  itself  to  bring  about  the 
very  disaster  which  is    dreaded.     It    would    of   course    be 


THE    CAUSES    OF    INSANITY.  273 

untruthful  to  deny  that  persons  so  related  are  exposed  to 
greater  chances  of  becoming  insane — are  more  obnoxious  to 
the  influence  of  stresses  tending  to  produce  insanity — than 
are  the  majority  of  other  people  ;  but,  on  the  other  hand,  it 
is  the  height  of  folly  to  suppose  that,  because  a  person  has 
one  or  more  brothers  or  sisters  who  are  insane,  therefore 
that  person  stands  in  imminent  or  urgent  danger  of  himself 
becoming  insane.  The  operation  of  the  laws  of  heredity, 
as  explained  in  a  previous  chapter,  secure  that  the  tendency 
of  each  individual  to  develop  in  the  direction,  in  the 
manner,  and  to  the  extent  of  the  average  individual  of  the 
race  from  whence  he  springs,  is  so  powerful,  that  it  will 
assert  itself  against  conditions  the  most  unfavourable  ;  so 
that  parents,  who  differ  very  widely  from  the  usual  standard 
of  the  race,  commonly  produce  children  who  approximate  to 
that  standard  very  closely  ;  and  even  if  they  produce  one,  or 
two,  or  more  children  who  inherit  their  peculiar  divergence 
from  this  standard,  the  chances  are  quite  as  great  that  the 
remaining  children  will  follow  the  usual  course  of  develop- 
ment, and  grow  into  normal  average  individuals,  as  that  they 
will  follow  the  development  of  their  parents,  and  inherit  their 
instability.  If  persons  situated  in  the  way  supposed,  that 
is,  related  to  insane  brothers  and  sisters,  and  on  that  account 
worrying  about  their  own  sanity,  Avere  aware  of  the  immense 
number  of  perfectly  normal  people  who  are  in  the  same 
predicament  as  themselves,  they  would  find  their  fears 
considerably  allayed. 

In  comparison  with  other  family  relationships,  that  of 
marriage  is  a  fertile  source  of  stresses  that  favour  the  pro- 
duction of  insanity  ;  and  the  reason  of  this  greater  fertility 
is  apparent.  In  adult  life  the  relation  to  parents  or  to 
brothers  and  sisters  is  not  an  extremely  important  one  ;  does 
not,  as  a  rule,  largely  influence  the  life,  the  conduct,  thoughts, 
and  emotions  of  an  individual  ;  but  the  same  cannot  be 
said  of  the  relationship  towards  husban  d  or  wife.  In  the  case 
of  a  man,  the  disposition,  character,  and  health  of  his  wife 
form    very    important    considerations  in    determining    his 

19 


274  SANITY    AND    INSANITY. 

conduct  and  mode  of  life,  and  are  potent  elements  in  direct- 
ing his  thoughts  and  arousing  his  emotions  ;  while  in  the 
case  of  a  woman,  whose  profession  and  business  it  is  to  be 
her  husband's  wife,  the  character  and  conduct  of  the 
husband  exercise  an  even  more  important  and  powerful 
influence  on  the  life,  the  physical  and  mental  well-being. 

Among  the  circumstances  of  this  relationship  that  are 
productive  of  stress,  the  most  potent  is  doubtless  conjugal 
unfaithfulness  in  the  other  party.  While  not  absolutely  a 
frequent  cause,  it  is,  relatively  to  other  family  circumstances, 
the  most  frequent  cause  in  this  group.  A  case  has  been 
related  in  an  earlier  chapter,  and  more  than  one  case  of 
the  kind  has  come  under  my  own  notice.  The  stress  is 
simply  that  commotion  of  the  nervous  molecules  which 
attends  intense,  violent,  and  continued  emotion  ;  and  does 
not  call  for  further  examination  as  to  its  nature. 

The  complementary  circumstance  of  unfaithfulness,  not 
in  the  other  party,  but  in  the  individual,  is  sometimes 
an  occasion  of  stress  that  becomes  a  factor  in  the  pro- 
duction of  insanity,  as  in  the  case  of  Lady  Mordaunt, 
who  became  insane  upon  being  made  respondent  in  a 
divorce  suit.  In  that  case  there  were,  of  course,  the 
additional  stresses  arising  from  the  public  exposure  of 
the  trial,  &c.  Without  unfaithfulness  in  either  party, 
stresses  occasionally  arise  from  the  relationship  of  mar- 
riage. The  marriage  with  an  individual  who  is  found  to 
be  extremely  unsuitable,  who  offends  against  every  instinct 
and  proclivity,  may  produce  enough  stress  to  cause  insanity 
in  the  individual  so  offended.  Or,  without  any  such  mani- 
fest unsuitability,  the  marriage  with  one  person,  when  the 
whole  affection  has  been  given  to  another,  may  be  an 
efficient  cause  ;  or  even,  it  is  probable,  the  mere  fact  of 
marriage  with  a  person  for  whom  no  affection  is  felt. 
The  case  of  Lady  Durham,  tried  before  Sir  James  Hannen 
in  March,  1885,  is  in  point. 

This  consideration  leads  directly  to  those  cases  in  which 
the   stress    which    occasions    the    insanity  is   the   loss  of  a 


THE    CAUSES    OF    INSANITY.  275 

lover.  Such  cases  are  frequently  referred  to  in  songs, 
and  occasionally  in  romances  ;  and  undoubtedly  such  cases 
do  occasionally  happen,  but  they  are  not  common.  The 
craving  of  human  nature  about  the  period  of  adolescence 
is  for  some  object  to  lavish  its  affections  on.  The  object 
fixed  upon  may  be  appropriate  or  it  may  not  ;  but  in  either 
case,  if  it  be  lost,  its  place  does  not,  in  the  vast  majority  of 
cases,  remain  long  vacant.  The  craving  is  too  powerful 
to  remain  unsatisfied,  and  as  the  majority  of  the  qualities 
which  constitute  the  appropriateness — that  is,  the  excel- 
lence— of  the  loved  object  exist,  not  in  that  object  but  in 
the  imagination  of  the  lover,  an  apparently  suitable  object 
is  easily  found,  and  the  affections  are  transferred  with  a 
readiness  which  often  causes  some  surprise,  and  even  some 
humiliation,  to  the  transferer. 

In  the  relationship  to  children  stresses  may  arise  which 
favour,  if  they  do  not  by  themselves  produce,  the  occur- 
rence of  insanity  ;  and  I  have  had  under  care  a  case  of 
insanity  which  was  ascribed  to  the  anxiety  and  worry 
produced  by  the  excesses  and  enormities  of  a  spendthrift, 
graceless  son. 

Besides  the  stress  arising  from  the  misconduct  of  children, 
there  is  that  arising  from  anxiety  as  to  their  means  of  sub- 
sistence. The  onset  of  poverty  and  adversity,  which  could 
easily  be  borne  if  the  individual  alone  were  concerned,  may 
become  a  source  of  dangerous  stress  from  the  fact  that  it 
will  involve  the  oifspring  also  ;  and  anxiety  as  to  their  fate 
under  such  circumstances  may  be  attended  by  an  amount 
of  stress  sufficient  to  produce  insanity.  In  September, 
1883,  William  Gouldstone  was  tried  at  the  Central  Criminal 
Court  for  the  murder  of  his  five  children.  He  was  a  sober, 
hard-working  man,  in  the  receipt  of  25s.  per  week.  In 
three  years  he  had  had  three  children,  and  in  six  months 
more  his  wife  was  confined  of  twins.  It  is  noteworthy  that 
his  means  of  subsistence  remained  the  same,  but  the  extra 
drain  upon  these  means  of  subsistence,  arising  from  the 
addition  of  two  more  children  to  his  family,  was  a  circum- 


276  SANITY    AND    INSANITY. 

stance  sufficiently  adverse  to  produce  stress  enough  to  cause 
insanity.  He  was  found  guilty  by  the  jury,  but  subse- 
quently respited  on  the  ground  of  insanity. 

In  addition  to  those  which  have  been  mentioned,  there 
are  certain  other  family  relationships  that  may  give  rise  to 
stress.  Among  these  the  most  frequent  and  the  most 
severe  is  the  case  of  seduction,  and  the  giving  birth  to 
a  child  by  an  unmarried  girl.  In  such  a  case  a  number  of 
causes  combine  to  produce  the  stress  to  which  the  insanity 
is  due.  There  is  the  overwhelming  and  intense  emotion 
of  shame  at  her  position.  There  is  the  prospect  of  her 
life  being  blighted  by  inability  to  obtain  employment,  to 
marry,  the  enhanced  difficulty  of  supporting  herself  there- 
after. There  is  the  additional  burden  upon  her  resources 
of  a  child  to  support.  There  is  very  often  the  additional 
stress  caused  by  the  loss  of  her  lover,  a  circumstance  which 
is  alone  sufficient  in  some  cases  to  induce  insanity.  Then, 
in  addition,  there  are  the  powerful  internally-arising  stresses 
of  pregnancy,  childbirth,  and  suckling  to  aid  and  reinforce 
the  other  forms  of  stress.  Under  the  circumstances  it  is 
not  to  be  wondered  at  that  a  considerable  number  of  cases 
occur  annually  of  insanity  in  young  unmarried  mothers. 

The  next  division  of  the  environment  that  we  have  to 
consider  as  a  source  of  stress,  is  that  which  comprehends 
the  social  and  political  circumstances  in  which  the  indivi- 
dual lives.  Man  is  by  nature  gregarious,  and  the  gregarious 
instinct,  though  not  a  very  prominent  one,  is  an  instinct 
of  enormous  volume  and  powerful  sway.  There  are  two 
ways  in  which  the  gregarious  instinct  affects  the  sanity 
of  the  individual. 

In  the  first  place,  for  this,  as  for  all  other  activities,  there 
must  be  an  outlet,  if  the  organism  is  to  remain  in  health. 
The  desire  for  companionship  of  our  kind  is  a  craving  as 
urgent,  although  not  so  immediate,  as  the  desire  for  food  ; 
and  just  as  the  bodily  health  suffers  when  the  individual 
is  deprived  of  food,  so  the  mental  health  suffers  when  he 
is  deprived  of  companionship.     We    do    not    so   often  see 


THE    CAUSES    OF    INSANITY.  277 

instances  of  this  deprivation  in  man,  but  we  have  abundant 
evidence  of  the  strength  of  the  instinct  in  other  gregarious 
animals.  Practical  dairymen  know  that  a  cow  placed  by 
itself  will  never  give  as  much  milk,  put  on  flesh  as  fast,  or 
be  as  profitable  in  any  way  as  one  which  has  the  companion- 
ship of  its  fellows.  A  horse  which  occupies  its  stable  in 
solitude,  and  runs  alone,  will  never  do  as  much  work  as  one 
which  has  a  companion  in  the  neighbouring  stall  and  runs 
in  double  harness.  When  a  hunter  is  put  out  to  grass,  it 
will  break  down,  or  surmount,  almost  any  obstacle  to  get 
into  another  meadow  in  which  other  horses  are.  Put  two 
or  more  animals  of  any  kind  on  a  common  to  graze,  and 
they  will  always  be  found  near  together.  So  it  is  with 
man.  The  man  who  lives  without  the  companionship  of 
other  men  of  similar  tastes  and  similar  mental  calibre,  lives  a 
mutilated,  unsatisfied,  unwholesome  existence  ;  and  he  w^ho 
lives  in  solitude  cannot  long  preserve  his  mental  health. 
Hence  the  system  of  solitary  confinement  for  long  periods 
in  prison  has  had  to  be  abandoned  on  account  of  the  large 
proportion  of  the  prisoners  who  became  insane.  Hence 
tenders  of  lighthouses  and  light-ships  are  very  prone  to 
melancholia.  Hence  men  who  tend  sheep  in  the  solitudes 
of  Australia  wall  walk  incredible  distances  and  undergo 
intolerable  hardships  for  the  sake  of  getting  once  more 
into  human  companionship  ;  and  if  this  companionship 
be  inaccessible,  they  become  insane.  "  This  alone  kills 
many  a  man,  that  they  are  tied  to  the  same  still,  as  a 
horse  in  a  mill,  a  dog  in  a  wheel,  they  run  round,  without 
alteration  or  news,  their  life  groweth  odious,  the  world 
loathsome,  and  it  embitters  their  highest  pleasures  that 
they  are  still  the  same." 

The  second  way  in  which  the  gregarious  instinct  affects 
the  conditions  of  sanity  is  by  the  influence  upon  the  indi- 
vidual of  the  particular  grcx  in  which  he  lives.  Every 
member  of  a  society  is  influenced,  to  an  extent  of  which 
he  himself  is  seldom  conscious,  by  the  character,  the  action, 
the  opinions  of  the  society  of  which  he  is  a  unit.     It  is  in 


278  SANITY    AND    INSANITY. 

their  simplest  and  most  separate  forms  that  all  phenomena 
are  most  plainly  exhibited  ;  and  if  we  notice  social  pheno- 
mena in  their  simplest  examples,  we  see,  very  conspicuously 
displayed,  the  influence  of  all  upon  each.  If  we  watch  the 
flight  of  a  flock  of  starlings,  fieldfares,  or  even  pigeons,  we 
shall  see  that  their  movements  are  actuated  by  a  una- 
nimity which  is  not  approached,  pace  Mr.  Puff,  even  upon 
the  stage.  A  great  flock,  consisting  of  many  hundred 
birds,  may  be  seen  to  wheel,  to  turn,  to  rise,  to  approach 
the  ground,  with  a  simultaneity  which  gives  to  the  whole 
flock  the  appearance  of  being  moved  by  a  single  impulse. 
Similarly  a  shoal  of  small  fish  may  be  seen  to  alter  the  rate 
and  direction  of  movement  in  such  a  way  that,  while  each 
individual  alters  its  movement  to  the  same  extent,  each 
remains  at  the  same  distance  from  its  neighbours,  and  the 
general  outline  of  the  shoal  is  unaltered.  In  these  pheno- 
mena we  see  two  principles  exemplified.  In  part  they 
are  no  doubt  due  to  the  similar  action  of  similar  circum- 
stances upon  similarly  organized  beings,  and  are  good 
examples  of  the  stringency  of  the  subjection  of  Conduct  to 
Law.  But  in  part  also  they  are  examples  of  the  tendency 
of  every  individual  of  a  society  to  follow  the  conduct  of  the 
majority  of  the  members.  All  the  members  of  the  flock 
or  of  the  shoal  are  not  subjected  to  quite  the  same  condi- 
tions, and  yet  the  conduct  of  all  is  virtually  identical,  so 
that  a  large  proportion  of  the  eflfect  must  be  set  down  to 
this  second  factor.  The  tendency  of  each  individual  to  act 
as  the  rest  act  is  so  strong  that  no  alternative  seems  possible. 
An  exception,  a  rebel,  a  case  of  individual,  independent 
judgment,  is  never  witnessed.  For  one  of  these  animals 
to  turn  in  a  contrary  direction  to  the  rest,  would  be  as 
impossible  as  for  a  tradesman  in  ancient  Egypt  to  change 
his  occupation,  or  for  an  English  country  squire  to  vote 
for  a  Radical.  The  conformity  of  conduct  is  the  result 
of  no  external  coercion.  It  is  the  outcome  of  an  organized 
mechanism  that  has  become  so  thoroughly  adapted  to 
combined  or  conventional  action,  that  independent  action 


THE    CAUSES    OF    INSANITY.  279 

is  inherently  impossible — is  in  the  line  of  greatest  resistance, 
internal  as  well  as  external. 

While  we  recognize  the  power  of  this  inherent  tendency, 
in  every  member  of  a  society,  to  follow  the  example  of  the 
rest,  we  must  not  omit  to  notice  that,  in  order  there  may 
be  an  example  to  follow,  some  individuals  must  take  the 
initiative.  There  must  be  in  some  individuals  a  tendency, 
not  to  follow,  but  to  lead  ;  not  to  imitate,  but  to  initiate. 
Yet  if  we  observe  the  movements  of  the  flock  or  of  the  shoal, 
we  see  among  its  members  such  an  almost  perfect  simul- 
taneity of  action,  as,  taken  together  with  the  sameness  in 
direction  and  the  equality  in  the  amount,  renders  us  certain 
that,  since  the  actions  are  so  closely  alike,  the  motives 
also  that  prompt  to  action  must  be  closely  alike  in  all. 
These  motives  we  have  seen  to  be  the  tendency  to  imi- 
tate others,  and  the  tendency  to  initiate  new  lines  of  action. 
Since  it  is  unlikely  in  the  extreme  that,  in  individuals  so 
closely  alike  in  other  respects,  there  should  be  a  difference 
so  great  as  that  one  should  be  wholly  imitative  and  another 
wholly  original,  we  are  led  to  the  conclusion  that  every 
individual  in  a  society  possesses  in  some  degree  both  of 
these  tendencies  to  action — the  tendency  to  conform,  to 
imitate  the  acts  prevalent  in  the  society  in  which  it  exists  ; 
and  the  tendency  to  originate,  to  initiate  new  actions,  to 
revolt,  to  rebel.  In  every  individual  these  tAvo  tendencies 
exist,  but  in  no  two  individuals  are  they  combined  in 
precisely  the  same  proportions.  Upon  the  strength  of 
the  initiative  or  conforming  tendency  is  founded  the  whole 
power  of  Mrs.  Grundy.  Her  dominion  rests  upon  fear — 
upon  the  fear  of  doing  that  which  is  not  customary,  which 
does  not  conform  to  the  customs  of  the  majority.  According 
to  the  degree  in  which  this  tendency  preponderates  over 
the  tendency  to  originate,  in  so  far  is  the  individual 
conservative  in  his  tastes,  opinions,  and  acts.  He  desires 
to  go  on  doing  what  the  majority  are  doing.  Any  depar- 
ture from  the  uniformity  of  action  of  all  the  members  of 
the    society  to   which^  he    belongs,   is    irksome  to   him  ;    it 


28o  SANITY    AND   INSANITY. 

offends  against  a  deep  instinct  of  his  nature  ;  it  impresses 
him  as  a  species  of  treachery  ;  as  mihtating  against  the 
stabiHty  of  the  social  organization.  If  all  the  birds  in  a 
flock  were  to  fly  at  random,  the  flock  would  disperse  ;  if 
all  the  fish  in  a  shoal  were  to  swim  at  random,  the  shoal 
would  be  scattered  ;  and  if  all  the  members  of  a  human 
society  were  to  discard  uniformity  of  action,  the  society  would 
fall  to  pieces.  It  is  the  dim  perception  of  this  fundamental 
truth  which  makes  the  conservative  so  tenacious  of  his 
conservatism,  and  so  bitter  in  his  opposition  to  the  party 
of  progress. 

On  the  other  hand,  the  possession  of  a  greatly  prepon- 
derating amount  of  the  initiative  or  originating  faculty 
makes  a  man  by  nature  a  rebel.  Perceiving  the  defects 
of  the  system  under  which  he  lives,  and  unrestrained  by 
the  coercive  agency  of  the  conforming  tendency,  he  desires 
to  loosen  the  bonds  of  the  social  organization  in  order  that 
its  elements  may  be  rearranged.  In  all  his  departures  from 
customary  proceeding  he  is  met  by  a  determined  opposition 
from  the  conforming  party.  It  is  in  vain  that  he  displays 
the  manifest  benefits  that  must  result  from  the  change  that 
he  advocates.  It  is  in  vain  that  he  appeals  to  past  experi- 
ence, and  shows  the  advantages  that  have  resulted  from 
similar  changes.  Arguments  are  powerless  against  instinct, 
and  it  is  an  instinct  that  he  has  opposed  to  him.  When 
once  his  reform  is  carried  ;  when  it  has  become  familiar  ; 
when  it  has  become  a  part  of  the  customary  order  of  things  ; 
then  the  same  instinct  will  mount  guard  over  it,  and  will 
defend  it  against  the  innovations  of  another  generation. 

It  is  upon  the  variations  of  these  two  tendencies  that  the 
existence  of  the  two  parties  of  Conservatism  and  of  Progress 
depends.  Since  the  tendencies  have  their  foundation  deep 
down  in  the  constitution  of  humanity,  we  should  expect 
their  manifestations  to  be  widespread  and  multiform,  and 
that  is  what  we  find.  Not  only  do  we  find  that  in  every 
nation  the  two  parties  of  Conservatism  and  Progress  are 
opposed  to  one  another,  but  we  find  the  same  opposition  in 


THE    CAUSES    OF    INSANITY.  281 

every  minor  aggregate  of  which  these  great  societies  are 
composed.  When  first  Macadam  proposed  to  improve  the 
roads  of  England,  and  substitute  a  firm  roadway  for  the 
sloughs  in  which  the  waggons  had  been  wont  to  get 
embedded,  a  pamphlet  was  published  which  had  for  its 
burden  the  question,  "  What  shall  we  do  if  we  leave  the 
old  ruts  ?  "  The  opposition  to  steam  locomotion  is  a 
matter  of  history,  and  in  every  trade  a  new  process  is 
looked  upon  with  a  disfavour  which  is  great  in  proportion 
to  the  novelty  of  the  proposal. 

The  interest  which  these  tendencies  possess  for  us  who 
study  insanity  is  twofold.  In  the  first  place,  as  with  all 
other  tendencies  to  feeling  and  conduct,  their  excess  is 
itself  insanity  ;  and  secondly,  where  the  conforming  ten- 
dency is  very  powerful,  and  the  individual  so  endowed  is 
placed  in  an  insane  environment,  he  may  become  insane 
by  the  mere  force  of  his  imitative  tendency. 

The  influence  of  the  Religious  environment  in  causing 
insanity  is  not  very  easily  computible,  for  so  much  more 
depends  on  the  individual  upon  whom  the  religious  circum- 
stances act  than  on  the  circumstances  themselves.  The 
close  connection  between  religious  fervour  and  sexual 
passion  has  already  been  adverted  to.  In  connection  with 
normal  development  a  large  body  of  vague  and  formless 
feeling  arises,  and  until  experience  gives  it  shape,  the 
possessor  remains  ignorant  of  the  source  and  nature  of 
the  feeling.  If  the  circumstances  are  appropriate  for  the 
natural  outlet  and  expression  of  the  activities,  they  are 
expended  in  aff'ection,  and  are  a  source  of  health  and 
strength  to  the  possessor.  But  if  no  such  natural  outlet 
exists,  the  vague,  voluminous,  formless  feelings  are  referred 
to  an  occasion  that  is  vague,  voluminous,  and  wanting  in 
definite  form — they  are  ascribed  to  the  direct  influence 
of  the  Deity,  and  assume  a  place  as  religious  emotion. 
In  all  this  the  religious  environment  takes  but  little  part  ; 
but  when  the  tide  of  emotion  has  once  been  directed  into 
the    religious   channel,  then    the    particular    manifestations 


202  SANITY   AND   INSANITY. 

in  which  it  finds  outlet  are  determined  by  the  nature  of 
the  rehgious  environment  ;  so  that  one  girl  becomes  a  nun, 
another  a  district  visitor,  and  a  third  a  hallelujah  lass. 
Some  of  those  who  seek  these  occupations  do  so  because 
they  happen  to  have  been  brought  up  in  a  convent  and 
have  had  no  inducement  to  leave  it,  or  because  no  other 
occupation  presents  itself,  and  they  happen  to  have  been 
thrown  in  the  way  of  the  particular  employment  which 
they  follow  ;  but  those  who  actually  seek  out  these  par- 
ticular modes  of  life,  do  so  because  in  them  the  religious 
emotion  is  unusually  powerful  or  prominent  ;  and  the  fact 
of  any  emotion  being  unusually  powerful  or  prominent 
is  itself  an  indication  that  that  particular  nature  is  not 
evenly  balanced,  and  that  in  it  disorder  will  be  more  readily 
provoked  than  in  the  normal.  With  such  natures  it  de- 
pends upon  the  character  of  the  religious  environment 
which  acts  upon  them  whether  they  remain  sane  or 
whether  they  become  insane.  So  long  as  the  circum- 
stances of  their  environment  are  such  as  to  provide 
abundance  of  employment  with  little  provocation  to 
emotion,  so  long  they  will  remain  sane  ;  but  let  them 
be  subjected  to  inactivity,  so  that  their  energies  have 
time  to  accumulate,  and  let  their  circumstances  be  highly 
provocative  of  emotion,  so  that  the  accumulated  energy 
tends  to  widespread,  intense,  and  unregulated  discharge, 
and  the  occurrence  of  insanity  becomes  a  question  only 
of  time  and  of  the  degree  of  excitement  that  the  circum- 
stances are  capable  of  producing.  Let  persons  of  such 
nature  be  taken  from  their  daily  avocations  and  subjected 
to  the  highly  exciting  circumstances  of  a  religious  "  revival," 
and  their  insanity  will  be  inevitable,  provided  the  excite- 
ment is  sufficiently  intense  and  long  continued.  Thus 
every  "revival "  is  attended  by  its  crop  of  cases  of  insanity, 
which  are  the  more  numerous  as  the  "  revival "  is  more 
fervent  and  long  continued. 


CHAPTER  XI. 


THE   FORMS   OF    INSANITY. 


If,  in  considering  the  causes  of  insanity  it  has  been  found 
necessary  to  depart  from  the  usual  practice  and  to  regard 
them  from  new  points  of  view  and  in  new  Hghts,  still  more 
is  this  necessary  when  the  forms  of  insanity  have  to  be 
dealt  with.  The  number  of  different  classifications  of  in- 
sanity is  the  same  as  the  number  of  writers  on  the  subject, 
each  individual  author  having  proposed  his  own,  which 
differs  in  some  point  or  other  from  all  the  rest.  Most  of 
these  classifications  are  founded  upon  a  general  principle, 
but  it  has  not  been  found  possible  to  apply  any  one  principle 
uniformly  throughout.  At  some  point  it  fails,  and  another 
principle  has  to  be  brought  in  ;  so  that  the  classification  com- 
prises, as  separate  and  mutually  exclusive,  such  groups  as 
Mania,  Epileptic  Insanity,  General  Paralysis  of  the  Insane, 
Puerperal  Insanity,  Dementia,  Idiocy,  &c. ;  which  is  much  as 
if  a  librarian  should  classify  his  books  into  histories,  books 
bound  in  cloth,  novels,  works  of  fiction,  octavo  volumes, 
periodicals,  and  books  published  in  London.  The  difficulties 
of  the  subject  are  certainly  extreme,  for  even  if  we  consider 
only  the  symptoms,  the  same  individual  may  at  different 
times  present  the  features  of  several  of  the  forms  of  insanity 
which  are  generally  recognized  as  distinct  ;  while  if  we 
consider  both  symptoms  and  causes,  as  is  often  done,  we 
may  have  to  classify  the  same  case  in  several  different 
groups,  and  find  that  for  another  case  there  is  no  group 
provided.  The  more  and  more  numerous  the  cases  of  in- 
sanity that  I  have  had  to  deal  with,  the  more  strongly  the 


284  SANITY    AND    INSANITY. 

fact  has  impressed  itself  upon  me  that  it  is  fruitless  to 
endeavour  to  draw  up  an  elaborate  scheme  of  classes,  orders, 
and  genera,  into  which  cases  of  insanity  are  to  be  grouped. 
No  such  divisions  exist  in  nature,  and  to  create  them  would 
be  a  highly  artificial  proceeding,  and  one  that  would  not 
accurately  represent  the  facts.  Certain  it  is,  that  there  are 
wide  differences  between  different  cases,  but  equally  certain 
is  it  that  the  differences  are  not  abrupt,  and  that  any  scheme 
of  division,  that  shall  correspond  with  the  facts,  must  separate 
the  cases  into  but  a  few  broad  and  comprehensive  groups, 
and  must  recognize  that  between  these  groups  no  exact  line 
of  demarkation  can  be  drawn.  Cases  will  always  occur 
partaking  pretty  equally  of  the  nature  of  two  adjoining 
groups,  and  other  cases  will  occur  which  exhibit  at  one  time 
the  features  of  one  group,  and  at  another  time  those  of 
another.  Nevertheless,  it  is  certain  that  cases  of  insanity 
do  differ  widely  among  themselves,  and  that  the  majority 
of  cases  resemble,  in  a  greater  or  less  degree,  one  of  a  fev/ 
well-marked  types.  A  very  common  mistake  has  been  to 
confuse  the  division  of  forms  of  insanity  with  the  division  of 
cases  of  insanity.  To  suppose  that  every  case  of  insanity 
exhibits  a  single  form,  and  persists  in  exhibiting  that  form, 
is  a  mistake.  The  same  individual  may  at  one  time  display 
one  form  and  at  another  time  another.  In  the  following 
consideration  of  the  forms  of  insanity,  regard  will  be  had 
only  to  the  nature  of  the  symptoms  displayed,  and  it  will  be 
understood  that  the  description  applies,  not  necessarily  to 
the  whole  course  of  a  case,  but  to  the  phenomena  that 
characterize  a  case  at  any  given  time. 

The  artificiality  of  current  divisions  becomes  apparent  when 
we  find  that  one  group  of  cases  of  insanity  is  included  under 
the  head  of  Mania,  another  under  that  of  Epileptic  Insanity, 
another  as  Puerperal  Insanity,  and  another  as  Senile  Insanity. 
Now  nearly  every  case  of  insanity  in  which  epilepsy  is  a 
frequent  and  regular  occurrence,  and  which  comes  therefore 
under  the  head  of  Epileptic  Insanity,  exhibits  maniacal 
outbursts  from  time  to  time,  and  then  becomes  a  case  of 


THE    FORMS    OF    INSANITY.  285 

mania.  Moreover,  almost  every  case  of  mania  which  goes 
on  to  its  natural  termination,  and  is  not  cut  prematurely 
short  by  some  intercurrent  disease,  exhibits  at  one  period  or 
another  of  its  course  an  attack  of  epilepsy.  Most  cases  of 
senile  insanity  are  subject  to  maniacal  outbursts,  and  many 
have  epileptic  attacks.  All  cases  of  puerperal  insanity  are 
more  or  less  maniacal  in  the  early  stage  of  the  malady. 
So  extraordinarily  varied  are  the  manifestations  of  insanity, 
that  it  has  been  said,  and  said  truly,  by  the  father  of 
alienism,  that  there  are  ''  scarce  two  of  two  thousand  that 
concur  in  the  same  symptoms.  The  Tower  of  Babel  never 
yielded  such  confusion  of  tongues  as  the  chaos  of  madness 
doth  variety  of  symptoms.  There  is  in  all  madness 
similitudo  dissimilis^  like  men's  faces,  a  disagreeing  likeness 
still  ;  and  as  in  a  river  we  swim  in  the  same  place,  though 
not  in  the  same  numerical  water  ;  as  the  same  instrument 
affords  several  lessons,  so  the  same  disease  yields  diversity  of 
symptoms.  Which,  howsoever  they  be  diverse,  intricate, 
and  hard  to  be  confined,  I  will  adventure  yet  in  such  a  vast 
confusion  and  generality  to  bring  them  into  some  order."  ^ 

Regarded  from  the  point  of  view  merely  of  the  symptoms 
that  they  present,  and  without  reference  to  the  occasion  on 
which  they  occur,  or  to  their  accompaniments,  the  forms  of 
insanity  are  not  numerous.  They  are  few  and  broadly 
distinguished  rather  than  numerous  and  strongly  marked. 
By  confining  ourselves  strictly  to  the  symptomatic  point  of 
view,  we  are  precluded  from  regarding  puerperal  insanity, 
epileptic  insanity,  phthisical,  religious,  or  gouty  insanities,  as 
distinct  varieties  or  forms.  We  recognize  that  different 
cases  of  insanity  may  have  the  puerperal  state,  phthisical 
lungs,  epilepsy,  or  gout,  as  antecedents  or  accompaniments, 
but  we  do  not  find  that  the  antecedent  or  the  accompani- 
ment gives  to  the  manifestations  of  the  insanity  an  in- 
dividuality sufficient  to  allow  us  to  infer  from  them  the 
nature  of  the  antecedent  or  accompaniment.  We  recognize 
that  the  antecedents,  or  occasions,  or  provoking "  causes  of 

^  Burton. 


2  86  SANITY   AND   INSANITY. 

insanity  are  various  and  numerous  ;  but  we  are  compelled  to 
admit  that  the  form  in  which  the  insanity  manifests  itself, 
the  symptoms  that  it  displays,  do  not  depend  exclusively, 
nor  even  largely,  upon  the  nature  of  the  stress  that  provokes 
it.  What  the  circumstances  are  which  determine  the  form 
that  the  insanity  takes  we  shall  presently  consider  ;  for  the 
moment  it  is  enough  to  point  out  that  among  these  cir- 
cumstances the  provoking  cause  is  not  an  important  factor. 

'  It  has  been  shown  in  an  earlier  part  of  the  book  that  the 
amount  of  intelligence  that  a  person  displays  depends  upon 
the  degree  of  development  of  his  higher  nerve  regions.  It 
has  been  shown  how,  according  as  the  process  of  develop- 
ment starts  with  a  vigorous  or  a  feeble  impulse,  it  is  carried 
forward  to  a  high  degree  of  elaboration,  or  becomes 
exhausted  when  a  comparatively  low  level  of  organization  is 
reached.  The  highest  nerve  regions,  being  the  last  and 
highest  effort  of  the  process  of  development,  the  flower  of 
the  unfolding  organism,  are  the  parts  which  are  most 
sensitive  to  any  defect  in  the  vigour  of  the  developmental 
process.  If  any  part  fails  to  reach  its  full  completion  owing 
to  the  premature  exhaustion  of  the  developmental  forces, 
that  part  will  be  the  highest  nerve  region.  If  any  part 
becomes  erroneously  developed,  owing  to  a  bias  or  fault  in 
the  developmental  process,  that  part  will  be  the  highest 
nerve  region.  These,  we  have  seen,  are  the  two  prime 
developmental  factors  in  the  production  of  insanity — 
deficiency  and  error  in  the  process  of  development — and  the 
first  great  division  of  the  forms  of  insanity  rests  upon  this 
difference  in  the  developmental  cause. 

Where  the  process  of  development  has  come  to  a  premature 
end,  and  the  higher  nerve  regions  have  never  attained  to  the 
average  development  of  the  race,  there  exists  congenital 
mental  deficiency,  the  dementia  naturah's  or  fatuity  a 
nativitate  of  jurists.  According  to  the  degree  in  which 
mental  capacity  is  deficient,  this  defect  is  styled  by  alienists 
weakness  of  mind,  imbecility,  or,  in  its  most  marked  degree, 


THE    FORMS    OF    INSANITY.  287 

idiocy  ;  but  the  latter  term  is  made  to  include  all  degrees, 
both  in  law  and  by  non-specialists  generally. 

Where  the  process  of  development  has  proceeded  to  the 
average  extent,  so  that  the  individual  has  attained  an 
average  degree  of  intelligence  ;  but  yet  has  become  defective 
in  its  later  stages,  so  that  a  proneness  to  insanity  is  left, 
which  tendency  has  been  made  actual  by  the  incidence  of 
some  stress  ;  in  such  cases  there  is  insanity  proper,  the 
dementia  accidentalis  vel  adventitia  of  jurists. 

Thus  it  will  be  seen  that  in  idiocy  and  weakness  of  mind, 
the  process  of  development  has  not  been  carried  y"^r  enough  ; 
while  in  insanity,  the  process  has  been  carried  far  enough, 
but  has  diverged  into  the  wrong  direction. 

In  weakness  of  mind  there  is  every  degree.  At  one  end 
of  the  scale  is  the  person  who  is  not  quite  up  to  the  average  ; 
who  is  found  by  his  friends  to  be  a  little  dull  ;  who  was  in  a 
lower  class  at  school  than  others  of  his  age  ;  who,  in  spite  of 
assiduous  study,  got  plucked  at  his  examinations  ;  who  is 
slow  to  appreciate  humour  ;  who  is  incapable  of  entertaining 
ideas  of  a  moderate  degree  of  abstractness  or  complexity  ; 
who,  if  he  reads  novels,  reads  those  only  which  deal  with 
incidents  and  adventures  ;  who,  if  he  admires  pictures, 
selects  those  which  portray  a  definite  act.  Such  men,  if  they 
possess  industry  and  power  of  application,  often  attain  a 
degree  of  success  in  life  which  surprises  those  who  know  the 
narrowness  of  their  intelligence  ;  the  fact  being  that  their 
interests  are  so  circumscribed  that  their  application  to  the 
object  they  have  in  view  is  not  apt  to  stray  ;  and  the 
attainment  of  an  end  depends  more  on  steady,  continuous 
application,  than  on  brilliance  of  mental  ability. 

Beneath  this  class  come  those  who  are  recognized  as 
being  definitely  "  deficient ;  "  as  being  not  merely  below  the 
average,  but  below  the  normal  ;  as  being  more  or  less 
imbecile.  The  line  that  divides  the  dull  or  weak-minded 
man  from  the  imbecile  is  the  ability  to  earn  a  living.  A 
man  who  can  earn  his  own  living,  whose  services  to  the 
community  are  of  sufficient  value  to  enable  him  to  maintain 


200  SANITY    AND    INSANITY. 

the  standard  of  liYing  proper  to  his  station  in  Ufe,  ma}'  be  a 
dull  man,  a  stupid  man,  a  man  of  feeble,  limited  intellect, 
but  he  cannot  be  called  an  imbecile.  Not  until  his  intel- 
lectual defect  is  so  grave,  that  by  reason  of  it  he  is  unable  to 
earn  his  livelihood,  does  it  become  imbecilit3\ 
i  The  distinction  between  imbecility  and  idiocy  is  less 
clearly  marked.  All  agree  that  the  latter  is  a  more  intense 
degree  of  the  same  defect  as  the  former,  but  there  is  no 
precise  criterion  by  which  the  one  can  be  distinguished  from 
the  other.  An  old  legal  definition,  as  quoted  by  Bucknill 
and  Tuke,  does  indeed  say,  *'He  that  shall  be  said  to  be  a  sot 
and  idiot  from  his  birth  is  such  a  person  who  cannot  count 
or  number  twenty  pence,  nor  tell  who  was  his  father  or 
mother,  nor  how  old  he  is,  so  as  it  may  appear  he  hath  no 
understanding  or  reason  what  shall  be  for  his  profit,  or 
what  for  his  loss  ;  but  if  he  have  suflficient  understanding  to 
know  and  understand  his  letters,  and  to  read  by  teaching 
and  information,  then  it  seems  he  is  not  an  idiot."  It  is 
doubtful  how  far  this  definition  would  be  accepted  at  the 
present  day.  There  is  an  old  proverb  which,  so  far  from 
regarding  as  idiotic  a  person  who  cannot  do  so,  regards  as 
endowed  with  exceptional  wisdom  the  child  who  knows  his 
own  father  ;  and  if  the  inability  to  tell  his  own  age  is  to 
render  a  person  liable  to  be  considered  idiotic,  I  know  of  at 
least  one  person  who  is  unable  to  withstand  that  test,  and  is 
yet  considered  of  average  intelligence  by  his  acquaintances. 
A  distinction  between  imbecility  and  idiocy  may,  however,  be 
drawn,  and  that  which  I  shall  propose  has  the  additional 
advantage  of  proceeding  upon  the  same  lines  and  belonging 
to  the  same  system  as  that  already  drawn  between  imbecility 
and  mere  weakness  of  mind. 

In  the  preceding  chapter  a  description  was  given  of  the 
various  classes  of  circumstances  to  which  this  human 
organism  has  by  its  activities  to  adapt  itself.  The  greater 
the  store  of  energy  which  the  organism  contains,  the  more 
completely  does  it  effect  its  adaptation  to  all  these  classes  of 
circumstances.    A  thoroughly  healthy,  vigorous  man  will  be 


THE   FORMS   OF    INSANITY.  289 

able  to  compass,  not  only  those  activities  by  which  he  avoids 
direct  physical  dangers ;  by  which  he  earns  his  livelihood ; 
and  by  which  he  rears,  feeds,  clothes,  and  educates  his  off- 
spring ;  but  will  be  able  also  to  take  his  part  in  social  func- 
tions, to  enjoy  social  meetings,  to  partake  in  political  move- 
ments, and  still  will  have  energy  to  spare  which  he  can 
expend  in  recreating  himself,  and  in  the  pursuit  of  art,  or  of 
some  hobby.  If,  however,  the  organism  is  somewhat  lacking 
in  vigour  and  energy,  it  will  no  longer  be  able  to  fdl  out  the 
entire  sphere  of  these  activities.  Some  of  these  circum- 
stances will  fail  to  evoke  the  activities  which  answer  to  them, 
and  by  which  the  organism  adapts  itself  to  them.  When 
energy  is  thus  lacking,  it  is  obvious  that  those  activities 
will  first  be  relinquished  which  are  least  essential  to  the 
support  of  life,  and  that  those  which  will  be  adhered  to 
most  tenaciously,  and  will  be  the  last  to  be  relinquished,  are 
those  which  are  the  most  immediately  essential  to  existence. 
Now  the  least  important  group  of  activities  is  no  doubt  that 
which  satisfies  the  recreative  and  assthetic  cravings,  and 
hence  when  energy  begins  to  fail,  this  is  the  point  at  which 
economy  is  effected.  Less  active  forms  of  recreation  are 
adopted,  less  energy  is  expended  in  this  direction  ;  a  quiet 
evening  over  a  pipe  takes  the  place  of  a  long  walk  or  of  a 
game  of  cricket  or  football.  As  the  feebleness  increases, 
first  the  social  and  political  activities  are  discontinued,  then 
comes  inability  to  maintain  the  wife  and  children,  then  the 
ability  to  earn  a  livelihood  fails,  and  finally  the  power  of 
avoiding  physical  dangers  is  lost.  If  we  look  at  the  reverse 
process,  and  notice  the  order  in  which  activities  are  acquired 
by  the  groAving  organism,  we  shall  find  the  order  is  precisely 
the  reverse  of  that  just  considered.  The  first  thing  the 
child  learns  is  to  avoid  physical  dangers — to  keep  from  fall- 
ing downstairs,  to  get  out  of  the  way  of  moving  bodies,  to 
avoid  being  knocked  down  and  run  over,  to  escape  falling 
into  the  water,  running  against  obstacles,  burning  and 
cutting  itself,  and  all  forms  of  physical  injury.  When  this 
class  of  circumstances  has  been  so  thoroughly  complied  Avith 

20 


290  SANITY    AND   INSANITY. 

that  danger  is  no  longer  to  be  apprehended  from  ordinary 
risks  ;  when  the  activities  answering  to  this  class  of  circum- 
stances has  been  thoroughly  acquired,  then,  and  not  till 
then,  begins  the  acquisition  of  those  activities  by  which  the 
livelihood  is  to  be  earned.  Then  begins  the  formal  process 
of  education,  which  is  the  first  step  in  fitting  the  individual 
to  get  his  living.  When  this  has  been  done,  when  sufficient 
time  has  been  spent  daily  in  the  acquisition  of  these 
activities,  then  what  remains  over  can  be  devoted  to  recrea- 
tion and  other  purposes. 

It  is  obvious,  upon  the  foregoing  considerations,  that  when 
an  individual  fails  to  reach  the  full  development  of  the  race, 
the  failure  will  be  first  noticeable  in  the  activities  that  are 
left  over  after  the  livelihood  has  been  gained  ;  hence  we  find 
that  in  the  first  degree  of  weakness  of  mind  the  individual 
is  able  to  earn  his  own  livelihood,  but  that  when  this  is  done 
his  energies  are  exhausted.  He  does  not  shine  socially,  he 
has  no  "  resources,"  no  hobby,  no  employment  for  his 
leisure  time.  Wife  and  children  he  may  have,  but  he  takes 
no  part  in  the  education  or  bringing  up  of  the  latter — he 
lets  them  find  their  own  way  about. 

In  the  next  degree  of  weakness  of  mind — in  imbecility — 
the  standard  of  activity  has  sunk  one  degree  lower.  The 
imbecile  is  unable  to  earn  his  own  livelihood.  That  is  the 
test  and  that  is  the  criterion  of  imbecility.  He  may  be 
capable  of  doing  odd  jobs,  and  of  executing  simple  work 
under  supervision,  but  his  services  have  not  sufficient 
market  value  to  bring  him  in  enough  to  support  life.  He 
cannot,  unassisted,  adapt  himself  to  Avhat  I  have  termed  his 
Vital  Environment.  His  activities  are  not  sufficiently 
developed,  and  this  degree  of  deficiency  of  development  is 
imbecility. 

In  idiocy  the  deficiency  is  still  greater.  The  imbecile  fails 
to  adapt  himself  to  his  Vital  Environment,  he  fails  to  com- 
plete the  second  step  in  his  intellectual  development;  but 
he  surmounts  completely  the  first  step,  that  which  enables 
him  to  adapt  himself  to  his  physical  environment.     He  can 


THE    FORMS    OF    INSANITY.  29! 

be  trusted  to  go  out  by  himself  without  running  the  risk  of 
being  knocked  down  by  passing  vehicles.  He  can  be  trusted 
to  cut  his  own  food  without  cutting  his  fingers.  But  the 
idiot  fails  to  effect  even  these  simple  adjustments  to  his 
circumstances.  He  is  not  only  incapable  of  earning  his  own 
living — of  adapting  himself  to  his  Vital  Environment — but 
he  is  incapable  of  preserving  himself  from  the  risks  of 
physical  harm  that  are  present  in  his  ordinary  Physical 
Environment.  So  incapable  is  he  of  conserving  himself 
against  ordinary  risks  that  he  cannot  be  left  alone.  Although 
of  adult  age,  he  has  not  proceeded  further  along  the  path  of 
development  than  a  young  child,  and  like  the  young  child 
he  requires  constant  attention.  If  left  by  himself  he  will  set 
himself  on  fire,  or  fall  into  the  water,  or  cut  himself,  or  get 
entangled  in  a  machine,  or  come  to  some  actual  physical 
harm  which  could  have  been  avoided  by  the  exercise  of 
rudimentary  intelligence.  He  fails  to  adapt  himself  to  the 
simplest  of  all  the  sets  of  circumstances  with  which  he 
has  to  deal,  and  this  extreme  degree  of  failure  constitutes 
idiocy. 

If  the  doctrine  here  advanced  is  true,  and  if  the  idiot 
differs  from  the  person  of  average  intelligence  in  the  fact 
that  the  former  has  not  proceeded  so  far  along  the  path  of 
development  as  the  latter,  then,  in  addition  to  the  evidence 
of  function,  we  shall  expect  to  find  evidence  in  the  structure 
of  the  idiot  showing  that  development  has  stopped  short 
before  reaching  completion.  We  shall  not  expect  to  find 
evidence  of  defect  in  the  early  stages  of  development,  for 
the  impetus  gained  at  conception  was  sufficient  to  carry  the 
organism  through  its  early  stages  successfully  ;  but,  as  the 
latest  stages  were  not  reached,  we  shall  expect  to  find  that 
the  latest  acquired  structures  are  wanting.  It  has  already 
been  explained  that  the  latest  acquired  structures — the 
flower,  as  it  were,  of  the  animal  organism — are  the  highest 
nerve  regions  ;  and  it  is  the  want  of  these  regions  which 
constitutes  the  main  physical  defect  in  idiocy.  Now  the 
highest  nerve  regions  are  situated  in  the  convolutions  of  the 


292 


SANITY    AND    INSANITY 
A 


KiG.  16.— Side  view  of  riglu  cerebral  hemisphere.    A,  normal 
adult  ;  B,  adult  idiot  ;  C,  new-born  child. 


THK    FORMS   OK    INSANFTV 
A 


293 


c 


Fig.  17. — Left  cerebral  hemisphere  seen  from  above.     A,  normal 
adult  ;  B,  adult  idiot  ;  C,  new-born  child. 


294  SANITY    AND    INSANITY. 

brain,  and  hence  when  these  regions  are  greatly  wanting  in 
development  we  shall  expect  to  find — (i)  That  the  convolu- 
tions of  the  brain  are  less  bulky,  contain  a  less  amount  of 
material  than  normal  ;  (2)  That  the  convolutions  are  less 
elaborate  and  less  complicated  in  structure  than  normal  ; 
and  (3)  That  the  adult  brain  which  has  failed  to  take  on  the 
later  stages  of  development,  resembles  the  brain  of  an  infant, 
to  whom  the  period  for  assuming  these  later  stages  of 
development  has  not  yet  arrived.  A  comparison  of  the 
Figures  16  and  17  will  show  how  far  these  reasonings  are 
bDrne  out  by  the  facts. 

Although  the  main  feature  in  idiocy  is  a  premature  failure 
in  the  process  of  development,  by  which  the  intellect  of  the 
idiot  is  permanently  arrested  at  the  childish  stage,  yet  there 
is  a  considerable  difference  betAveen  the  conduct  and  general 
mental  condition  of  the  idiot  and  that  of  the  child.  This 
difference  is  accounted  for  by  the  fact  that  the  adult  idiot 
is  older  than  the  child  ;  that  is  to  say,  that  although  the 
nervous  structure  has  not  increased  in  elaborateness  beyond 
the  childish  stage,  yet,  since  the  age  of  childhood  was 
passed,  the  tissues  have  been  altering  with  the  increased  age 
of  the  individual,  and  these  alterations  of  tissue  have  of 
course  been  reflected  in  the  nervous  system,  and  especially 
in  those  regions  which  are,  in  the  imperfect  individual,  the 
highest.  The  nervous  system,  too,  in  so  far  as  it  is  deve- 
loped, undergoes  with  advancing  years  the  same  process  of 
consolidation  and  settlement  that  takes  place  in  that  which 
has  reached  the  full  stature  of  normal  development  ;  so  that 
the  idiot,  while  similar  to  the  child  in  the  simplicity  and 
rudimentary  character  of  his  nervous  system,  of  his  conduct 
and  of  his  mind,  yet  lacks  the  buoyancy,  the  spontaneity,  the 
freshness  of  childhood,  and  presents  a  strange  mixture  of 
childishness  and  maturity  which  is  painful  to  see,  and  which 
is  at  once  recognized  as  abnormal. 

In  the  idiot,  as  in  the  person  of  full  mental  competence, 
the  revolution  of  puberty  takes  place.  It  occurs  later,  it  is 
true,  and  is  less  complete,  less  thorough,  and   often  more 


THE   FORMS   OF    INSANITY.  295 

gradual  ;  but  it  occurs,  and  corresponding  alterations  take 
place  in  the  imperfect  nervous  system  of  the  idiot  Avhich  are 
unknown  in  that  of  the  child.  The  higher  regions  of  the 
nervous  system  being  undeveloped,  and  the  lower  regions 
having  reached  a  degree  of  development  which  is  com- 
paratively much  further  advanced,  it  results  that  the  due 
and  proper  balance  between  the  higher  and  the  lower 
regions  is  not  maintained.  That  control  which  it  is  the 
function  of  the  hio-her  regions  to  exercise  over  the  lower  is 
inefficient,  and  the  lower  regions  tend  to  overact — to  act  too 
strongly  and  too  continuously.  Hence  we  find  that  among 
idiots  and  imbeciles  the  lower  appetites  and  propensities  are 
unduly  displayed.  They  are  greedy  for  food  and  drink, 
their  sexual  passions  are  seldom  at  rest,  if  of  sufficient 
intelligence  they  are  usually  thieves,  and  they  are  subject  to 
outbursts  of  rage  upon  trifling  provocation. 

Occasionally  a  case  of  imbecility  presents  itself,  in  which, 
while  the  general  intellectual  powers  are  markedly  deficient, 
one  isolated  group  of  faculties  is  of  average,  or  even  more 
than  average,  development.  Such  are  the  cases  in  which 
persons,  otherwise  imbecile,  show  a  talent  for  music  or  for 
calculation.  In  such  cases  we  must  suppose  that  the 
deficiency  in  cerebral  development  is  not  uniform,  but  that 
in  some  directions  the  development  has  proceeded  to  the 
normal  extent,  w^hile  in  the  remainder  it  has  failed. 

While  the  failure  in  the  last  stages  of  development  is 
always  most  conspicuous  in  the  higher  nervous  regions, 
whose  development  occurs  wholly  in  the  latest  stages,  yet,  if 
the  failure  is  considerable,  and  has  begun  before  these  last 
stages  are  reached,  it  wiirexhibit  itself,  not  only  in  defect  of 
the  higher  nerve  regions,  but  also  in  defect  of  other  attri- 
butes of  the  organism  which  appear  towards  the  completion 
of  its  development.  Among  the  attributes  which  are  late 
in  appearing  are  the  attainment  of  the  full  stature  and  bulk 
of  the  adult,  and  when  the  process  of  development  fails 
prematurely,  before  the  adult  stature  and  bulk  are  acquired, 
they  are  never  afterward  reached,  and  consequently  we  find 


296  SANITY    AND    INSANITY. 

that  most  imbeciles  and  all  congenital  idiots  are  much  under 
the  average  in  stature  and  weight. 

Since  the  higher  nerve  regions  remain  undeveloped,  the 
total  amount  of  nerve  tissue  at  the  service  of  the  individual 
is  below  the  normal.  Comparison  of  the  Figures  16  and  17 
will  indicate  how  conspicuously  the  nerve  masses  of  the 
idiot  are  deficient  in  bulk.  But  the  great  nerve  masses,  the 
brain  and  spinal  cord,  are  the  great  reservoirs  for  the 
storage  and  supply  of  energy  to  the  body  ;  and  hence,  if 
these  nerve  masses  are  conspicuously  deficient  in  bulk,  the 
amount  of  energy  at  the  disposal  of  the  organism  must  be 
conspicuously  deficient.  Hence  we  find  that  idiots  and 
imbeciles  are  always  inactive  :  given  to  sitting  and  lolling 
about,  disinclined  for  even  such  simple  modes  of  activity  as 
they  are  capable  of,  lethargic  and  indolent. 

Doubtless  those  who  are  familiar  with  the  peculiarities  of 
idiots  and  imbeciles  will  demur  to  the  generality  of  the 
foregoing  statement.  While  admitting  that  the  majority  of 
the  individuals  so  aflflicted  are  indolent  and  lethargic,  they 
will  point  to  here  and  there  an  exception.  Dealing  here 
Avith  the  broad  outlines  of  the  subject,  and  being  unable  to 
go  into  detail  to  explain  exceptional  cases,  it  will  be  enough 
to  say  that  the  description  here  given  is  true  of  those  cases 
in  which  the  process  of  development  has  come  to  a  pre- 
mature end  by  reason  of  its  own  exhaustion — because  of 
deficiency  in  the  original  impetus  which  set  it  going — 
because  it  has,  as  it  were,  run  itself  out.  But  it  mav  happen 
that  the  developmental  process,  instead  of  dying  a  natural 
death  in  this  way,  may  be  brought  to  a  violent  end.  An 
injury  to  the  head,  an  intracranical  inflammation,  undue 
pressure,  the  presence  of  a  poison  in  the  blood,  or  other 
cause  acting  in  very  early  life,  may  so  distort,  disturb,  and 
arrest  the  development  of  the  brain  as  to  produce  idiocy  ; 
and  in  such  cases,  which  are  common,  the  symptoms  will 
differ  from  those  of  the  classical  type  ;  but  these  differences 
it  is  not  worth  while  to  pursue  here. 

In  every  deep  there  is  a  deeper  depth,  and  even  in  idiocy 


THE    FORMS    OF    INSANITY.  297 

there  are  degrees  of  defect,  some  being  less  and  some  more 
severely  affected.  An  extension  of  the  test  already  applied 
serves  to  distinguish  them.  While  idiocy  differs  from  im- 
becility in  the  incapability  of  performing  adjustments  to  a 
simpler  set  of  circumstances  in  the  environment,  the  diffe- 
rent grades  of  idiocy  are  distinguished  by  the  more  and  more 
fundamental  and  necessary  character  of  the  adjustments 
which  alone  can  be  made.  The  idiot  who  can  dress  and 
undress  as  well  as  feed  himself,  is  superior  to  him  who  can 
perform  the  latter  act  but  not  the  former  ;  he  who  cannot 
feed  himself,  but  can  stand  and  walk,  is  less  idiotic  than 
the  wretched  being  to  whom  even  these  simple  acts  are 
impossible. 

Leaving  now  the  consideration  of  those  forms  of  unsound- 
ness of  mind  which  are  due  to  original  defect  in  the  extent 
of  the  developmental  process,  we  may  go  on  to  consider 
those  in  which  development  proceeded  to  the  normal 'extent, 
but  the  later  stages  were  wanting  in  stabilitv. 


CHAPTER  XII. 

THE    FORMS    OF    INSANITY    ('  Coutl'jiucd J . 

The  whole  of  the  foregoing  discussion  has  been  conducted 
under  the  guidance  of  a  single  fundamental  principle  :  the 
principle  that  no  disorder  of  organic  processes  is  the  result 
of  the  importation  of  an  entirely  new  element  into  their  work- 
ing. We  have  recognized  throughout  that  every  case  of 
disorder  was  but  the  exaggeration  of  some  normal  mode, 
constituent,  or  element  in  the  healthy  working  of  the  bodily 
processes.  There  is  no  phenomenon  that  can  be  produced 
by  disease,  however  bizarre,  startling,  and  marvellous  it  may 
appear,  which  has  not  its  counterpart  in  little  in  the  healthy 
organism.     Disease  does  not  create,  it  merely  exaggerates. 

Keeping  fast  hold  of  this  principle,  which  has  served  us  so 
well  hitherto,  it  is  natural  to  ask  whether  the  manifestations 
of  insanity,  startling,  bizarre,  and  marvellous  as  they  are, 
have  not  some  less  exaggerated  counterpart  in  the  normal 
manifestations  of  mind  and  conduct  in  sane  people  ;  and 
whether,  by  identifying  these  counterparts,  we  may  not  be 
able  to  trace  the  disorders  of  insanity  to  their  source,  and 
discover  where  and  how  they  diverge  from  the  processes  of 
health.  In  working  upon  these  lines,  it  is  manifest  that  we 
must  not  begin  with  those  manifestations  which  are  most 
extravagant  and  most  divergent,  but  rather  with  those 
which  are  less  strongly  marked,  and  present  the  least  striking 
differences  from  the  normal. 

Regarding  the  phenomena  of  health  from  the  point  of 
view  of  their  proximity  to  insanity,  we  find  that  there  are  at 
least  two  sets  of  phenomena  which  tend  naturally  and  in- 


THE    FORMS    OF    INSANITY.  299 

evitably  to  occur  in  the  life-history  of  every  individual,  and 
which  exhibit  an  unmistakable  kinship  to  insanity.  The 
first  of  these  is  sleep,  and  the  second  is  the  decadence  that 
occurs  in  old  age.  There  is  a  third  group  of  phenomena 
which  does  not  actually  lie  within  the  normal,  and  yet  is  not 
far  distant  from  it ;  which  reproduces  with  absolute  accuracy 
all  the  features  of  insanity  ;  which  is,  in  fact,  so  long  as  it 
lasts,  unquestionable  insanity  ;  and  yet  from  the  ease  with 
which  it  can  be  produced,  from  its  transient  duration  and 
manifest  cause,  is  not  considered  insanity  ;  which  connects 
the  wholly  normal  phenomena  of  sleep  and  of  old  age,  with 
the  wholly  abnormal  phenomena  of  insanity.  This  is  the 
group  of  phenomena  produced  by  alcoholic  intoxication. 
Thus  we  have  in  sleep,  old  age,  and  intoxication,  a  series  of 
approximations  to  insanity. 

Normal  sleep  is  a  temporary  and  complete  dementia.  It 
is,  in  fact,  the  last  and  complete  stage  of  dementia  which  is 
known  as  coma.  The  higher  nerve  regions  are  placed 
completely  out  of  action,  they  cease  altogether  to  emit 
energy,  and  are  occupied  solely  in  molecular  redintegration, 
and  in  storing  up  energy  for  future  use.  Since  the  higher 
nerve  regions  are  the  actuators  of  conduct,  when  these 
regions  cease  to  act,  conduct  is  abolished  ;  and  hence  during 
sleep  there  is  no  conduct  ;  the  organism  remains  motionless. 
The  action  of  the  highest  nerve  regions  is  attended  by  feel- 
ing and  thought  ;  and  hence,  when  these  regions  cease  to 
act,  feeling  and  thought  are  abolished  ;  and  during  sleep 
there  is  no  consciousness.  Normal  sleep  is  therefore  a 
sudden,  complete,  physiological  or  healthy,  extreme  dementia, 
occurring  normally  once  in  twenty-four  hours. 

Since  the  higher  nerve  regions  exercise  control  over  the 
lower  ;  and  since  at  the  onset  of  sleep  the  higher  regions  are 
placed  out  of  action,  it  might  be  expected  that  this  suspen- 
sion of  the  action  of  the  higher  regions  would  be  accom- 
panied by  an  over-action  of  the  lower,  due  to  the  removal  of 
control  ;  but  this  does  not  usually  occur  ;  and  the  reason  of 
its  non-occurrence  is  this  :  that  the  suspension  of  function 


2,00  SANITY    AND    INSANITY. 

affects,  not  the  highest  regions  only,  but  the  whole  of  the 
nervous  system  from  top  to  bottom.  The  whole  system  is 
affected  simultaneously,  but  not  uniformly.  The  function  of 
the  highest  regions  is  completely  obliterated ;  that  of  the 
middle  regions  is  greatly  diminished,  without  being  quite 
obliterated  ;  and  the  operation  of  the  lowest  regions  is 
rendered  slower  and  weaker,  but  is  less  affected  than  that  of 
the  middle.  So  that  while  conduct,  the  function  of  the 
highest  regions,  together  with  its  accompaniments,  thought 
and  feeling,  are  completely  obliterated  ;  movements,  the 
outcome  of  the  action  of  the  middle  regions,  while  greatly 
diminished  in  number  and  frequency,  do  occasionally  take 
place  during  sleep  ;  and  the  action  of  heart,  lungs,  and 
viscera,  regulated  by  the  lowest  centres,  still  continues, 
although  decidedly  diminished  in  vigour  and  intensity. 
Although,  therefore,  by  the  cessation  of  the  action  of  the 
highest  nerve  regions,  control  is  removed  from  the  lower, 
and  hence  there  arises  a  tendency  for  the  lower  to  over-act, 
on  the  other  hand  this  tendency  is  nullified  by  the  simul- 
taneous diminution  of  the  activity  of  the  lower  centres. 

Except  in  childhood,  the  normal  course  of  sleep  is  not 
often  maintained  in  perfect  integrity.  The  obliteration  of 
function  no  longer  takes  place  with  perfect  uniformity.  In- 
stead of  the  whole  of  the  higher  regions  being  gradually, 
uniformly  and  equally  submerged  beneath  the  flood  of 
inactivity,  islets  are  left  outstanding,  which  still  retain  more 
or  less  of  irregular  activity,  while  all  the  regions  surrounding 
them  are  at  rest.  In  the  common  case,  the  amount  of  activity 
in  these  isolated  regions  is  not  sufficient  to  set  in  action  the 
lower  centres,  and  to  produce  actual  movements  of  the  body, 
but  it  is  enough  to  have  accompaniments,  more  or  less  vivid, 
of  feeling  and  of  thought  ;  and  these  isolated  scraps  of  feeling 
and  thought,  accompanying  the  activity  of  islets  of  the 
higher  nerve  regions  unsubmerged  beneath  the  tide  of  sleep, 
constitute  the  phenomena  of  dreams. 

The  activity  of  these  isolated  regions  varies  in  intensity. 
Where  it  is  but  weak,  the  dreams  are  of  but  faint  intensity  ; 


THE    FORMS    OF    INSANITY.  ^OI 

where  it  is  considerable,  the  dreams  are  vivid.  In  rare  cases 
it  happens  that  the  activity  of  these  isolated  regions  reaches 
so  high  a  degree  that  it  sets  in  action  the  lower  centres,  that 
it  spreads  downwards  to  the  muscles,  that  it  produces  move- 
ments— conduct — of  a  kind  corresponding  with  the  limited 
amount  of  brain  involved  in  producing  it,  and  in  such  cases 
are  displayed  the  phenomena  of  somnambulism. 

Somnambulant  actions  differ  from  normal  actions  in  dis- 
playing a  partial  adjustment  only,  to  the  circumstances  in 
which  they  occur.  The  somnambulist  finds  his  way  about 
his  house,  avoids  obstacles,  goes  upstairs  and  downstairs,  un- 
locks the  door  and  gets  out  into  the  street.  He  can  adjust 
his  acts  to  circumstances  which  are  simple  and  well-known  ; 
but  put  him  in  a  strange  room,  and  he  will  open  a  cupboard 
door  and  try  to  make  his  way  out  through  that  ;  or  let  him 
get  upon  a  strange  landing,  and  he  will  be  likely  to  fall 
down  the  stairs.  A  portion  only  of  his  higher  nerve  regions 
being  at  work,  and  that  portion  not  including  any  of  the 
highest  of  all  ;  the  whole  of  the  impressions  made  by  circum- 
stances are  not  received.  A  large  part  of  the  currents  pro- 
duced by  these  impressions  go  to  parts  of  the  brain  which 
are  inactive,  which  do  not  respond,  and  are,  for  the  purposes 
of  guidance,  lost.  Since  the  circumstances  are  imperfectly 
perceived,  the  adjustment  to  them  must  be  imperfect.  Then, 
too,  of  the  adjusting  apparatus,  only  a  small  part  is  in  action  ; 
and  for  this  reason  also  the  adjustment  must  be  defective. 

Thus  from  the  study  of  sleep  we  gather  the  following  con- 
clusions :  I.  That  a  periodical  cessation  of  action  of  the 
higher  nerve  regions,  with  diminution  of  action  of  the 
nervous  system  generally,  is  a  normal  and  healthy  habit. 
2.  That  the  cessation  of  action,  while  normally  uniform  and 
simultaneously  progressive  over  the  whole  of  the  higher 
nerve  regions,  yet  in  the  vast  majority  of  cases  departs  some- 
what from  this  uniformity,  so  that  certain  regions  and  areas 
are  commonly  later  and  less  affected  by  the  subsidence  into 
inactivity  than  the  remainder.  3.  That  in  some  cases  the 
amount  of   activity  retained  by  certain  areas  is  enough  to 


302  SANITY    AND    INSANITY. 

actuate  simple  forms  of  conduct,  and  to  produce  imperfect 
adjustments  of  the  individual  to  his  surroundings. 

It  not  unfrequently  happens  that  at  the  time  that  should 
be  devoted  to  sleep,  sleep  is  not  obtainable.  For  some  reason 
the  nervous  molecules  do  not  subside  into  the  quiescent  con- 
dition, that  accompanies  and  gives  rise  to  sleep,  but  main- 
tain their  function  of  emitting  energy  at  a  time  when  they 
should  be  wholly,  or  almost  wholly,  employed  in  storing  it. 
When  this  is  the  case — when,  in  spite  of  inactivity  of  the 
body,  the  recumbent  posture,  and  the  absence  of  spontaneous 
exertion,  sleep  fails  to  occur,  and  the  cerebral  molecules  still 
emit  streams  of  energy  instead  of  confining  themselves  to  the 
reception  of  energy  for  future  expenditure,  certain  pecu- 
liarities of  action  are  observed.  The  expenditure  of  energy, 
although  proceeding  from  a  wide  area,  including  the  highest 
nerve  regions,  is  yet  of  extremely  low  tension.  The  natural 
diurnal  tides  in  the  tension  of  the  nervous  energy  have 
already  (p.  95)  been  described.  The  lowest  ebb  of  these 
tides  is  in  the  small  hours  of  the  morning,  and,  whether 
sleeping  or  waking,  the  ebb  still  takes  place.  If  the  molecules 
of  the  higher  nerve  regions  become  wholly  quiescent  over 
the  whole  area,  the  condition  is  one  of  dreamless  sleep.  If 
they  become  generally  quiescent,  but  leave  small  isolated  areas 
of  activity  outstanding,  the  condition  is  one  of  sleep  with 
dreams.  But  if  there  remains  activity  over  wide  areas,  then 
there  is  wakefulness — a  vigil  both  of  consciousness  and  of 
bodily  function.  But  the  condition  of  the  nerve  function  in 
nocturnal  vigil  is  not  the  same  as  in  the  activityof  the  daytime. 
Although  the  full  daylight  of  consciousness  may  exist  in  each 
case,  and  although  equally  wide  areas  of  the  highest  nerve 
regions  may  in  each  case  be  active,  yet  the  activity  is  not  alike 
in  the  two  cases.  In  the  daytime,  not  only  is  there  a  wide 
area  of  discharging  grey  matter,  but  this  wide  area  is  dis- 
charging at  high  tension,  and  all  the  nerve  channels  are  filled 
to  repletion  with  abounding  copious  currents  of  energy, 
everywhere  pressing  against  their  boundaries  and  everywhere 
trying  to  escape.     But  in  nocturnal  vigil,  although  the  area 


THE    FORMS   OF    INSANITY.  303 

of  activity  is  equally  wide,  the  intensity  of  the  activity  is  very 
greatly  inferior.  The  currents  of  energy  permeate,  indeed, 
as  many  channels,  or  nearly  as  many,  as  in  the  daytime,  but 
they  pass  along  the  channels  in  driblets.  So  far  from  filling 
the  channels  to  repletion,  they  trickle  through  them  in  run- 
lets of  little  pressure  and  little  intensity.  What  will  be  the 
consequences  and  Avhat  the  accompaniments  of  this  reduction 
of  intensity  in  the  nerve  currents  ?  The  consequence  will 
be  that  movements — the  movements  which  make  up  conduct 
— will  be  few,  feeble,  and  sluggish.  The  conduct  will  be  sunk 
in  lethargy.  Little  will  be  done,  and  that  little  slowly,  feebly, 
and  with  difficulty.  The  other  movements,  too,  which  all 
owe  their  activity  to  that  of  the  nerve  currents,  will  be 
similarly  affected.  The  molecular  movements  of  nutrition 
will  be  feeble  and  sluggish  ;  the  modifications  of  nutrition — 
the  processes  of  secretion  and  excretion — will  be  similarly 
inactive.  The  visceral  movements,  the  action  of  heart,  lungs, 
and  intestines  will  all  fall  to  a  very  low  phase  of  activity. 
Concomitantly  with  this  inactivity  of  body,  the  mental  states 
will  be  less  vivid  ;  but  the  chief  alteration  in  consciousness 
will  be  that  diminution  of  the  feeling  of  well-being  which 
always  accompanies  a  reduced  tension  of  the  nervous  energy. 
Nothing  is  more  characteristic  of  nocturnal  vigil  than  the 
feeling  of  wretchedness  which  accompanies  it.  As  we  lie 
awake  in  the  small  hours  of  the  morning,  the  horror  with 
which  the  situation  inspires  us  surprises  us  even  then,  and  is 
a  matter  of  amazement  in  the  subsequent  light  of  day.  Then, 
in  those  dark  hours,  all  our  mistakes,  all  our  follies,  rise  up 
in  a  black  legion  to  menace  and  taunt  us.  The  long-forgotten 
sins  of  our  youth  push  themselves  forward,  and  demand  to  be 
recognized  and  remembered.  The  difficulties  of  our  daily  life 
swell  and  grow  to  impossibilities.  If  we  look  back  we  are  con- 
fronted by  remorse  ;  if  w^e  look  forward  we  are  met  by  despair. 
Turning  now  to  the  phenomena  of  old  age,  we  notice  that 
the  most  obvious  and  striking  characteristic  of  the  onset  of 
this  period  of  life  is  a  general  diminution  of  activity.  The 
impetus,  that  was  given  to  the  organism  at  conception,  has 


304  SANITY    AND    INSANITY. 

carried  it  on  through  the  process  of  development  to  man- 
hood, has  sustained  it  in  activity  throughout  a  long  life,  but 
Avith  each  year  that  has  passed  a  portion  of  the  initial 
velocity  has  been  dissipated.  The  friction  with  the  world 
has  tended  constantly  to  bring  the  organism  to  rest,  and  as 
its  career  approaches  termination,  it  moves  more  and  more 
slowly.  The  bones  of  the  child  are  composed  largely  of 
gristle,  the  earthy  matter  in  their  composition  is  com- 
paratively little  ;  they  can  be  cut  with  a  knife  ;  they  can  be 
bent  without  breaking;  their  weight  is  light;  they  easily  yield 
to  the  stresses  of  weight  and  of  muscular  action,  and  become 
altered  in  shape.  In  the  old,  the  bones  are  stony  hard,  they 
are  brittle,  heavy,  rigid,  and  unaltering.  As  with  the  bones 
so  with  the  other  tissues.  The  nervous  system  of  the  child 
is  impressible,  plastic,  easily  moulded,  easily  altered,  is  con- 
tinually the  seat  of  new  combinations  and  new  development. 
In  the  old  man  the  nerv^ous  system  is  stirred  with  difficulty. 
The  movements  of  the  molecules  are  sluggish  ;  new  com- 
binations are  slow  to  form  ;  widespread  commotions  are 
difficult  to  effect.  The  structure  becomes  rigid,  so  that  the 
slight  alterations  that  are  impressed  upon  it  are  readily 
effaced.  Forced  for  a  moment  into  new  combinations,  the 
rigidity  of  the  tissue  prevents  these  combinations  from 
becoming  permanent.  The  old  forces  soon  resume  their  sway, 
and  the  molecules  fall  back  into  their  old  positions. 

The  diminished  mobility  of  the  molecules  of  the  nervous 
system  is  evidenced  most  conspicuously  by  the  general 
diminution  of  the  bodily  movements  in  old  age.  The  chief 
characteristic  of  youth  is  its  buoyant,  spontaneous,  eager 
activity  ;  old  age  presents  the  antithetical  condition  of 
quiescence,  repose,  inactivity.  The  corresponding  pecu- 
liarities of  nerve  tissue  are,  in  the  young,  a  copious  store  of 
energy,  freely  expended  and  readily  renewed  ;  in  the  old,  a 
diminished  store  of  energy,  requiring  stronger  stimulus  for 
its  arousal,  and  renewed  but  slowly  after  expenditure.  In 
these  characteristics  the  brain  of  the  old  man  resembles  that 
of  the  young  after  labour  and  at  the  approach  of  sleep. 


THE    FORMS    OF    INSANITY.  305 

This  diminution'  in  activity  that  occurs  in  old  age  does 
not  weigh  equally  upon  all  the  regions  of  the  nervous 
system.  It  pervades  indeed  throughout,  but  is  not  quite 
uniform  throughout.  The  highest  regions  are  the  most 
affected,  the  middle  regions  less,  and  the  lowest  least  ;  so 
that  while  the  intellect  is  dull  and  the  emotions  are  feeble, 
while  conduct  becomes  both  less  strenuous  and  less  elaborate, 
the  bodily  movements  remam  fairly  efficient,  and  the  heart's 
action  is  not  greatly  impaired.  In  this,  again,  the  quiescence 
of  old  age  resembles  the  quiescence  of  sleep. 

Another  striking  peculiarity  of  old  age  is  its  inability  to 
assimilate  new  impressions.  The  nervous  structure  is  no 
longer  plastic,  the  molecules  of  the  ground  substance  are 
settled  in  their  places,  and  oppose  increased  inertia  to  the 
efforts  of  errant  currents  endeavouring  to  force  channels 
through  them.  The  diminution  in  the  amount  of  free  energy, 
by  lessening  the  intensity  of  the  currents,  ensures  that  this 
increased  resistance  is  acted  on  by  diminished  forces  ;  and 
hence  new  combinations  are  made  slowly  and  with  difficulty, 
and  the  more  slowly  and  laboriously,  the  more  of  novelty 
they  contain.  It  is  an  old  and  accurate  observation  that 
''  you  cannot  teach  an  old  dog  new^  tricks."  A  lad  of 
twenty  may  easily  change  his  occupation  in  life  and  take  up 
one  entirely  new,  but  a  man  of  sixty  must  continue  in  the 
profession  that  he  has  follow^ed  all  his  life.  Send  a  boy  to  a 
foreign  country,  and  in  a  few  weeks  he  will  speak  the 
language  passably  well  ;  but  an  old  man  in  the  same 
circumstances  still  needs  an  interpreter. 

Even  when  new  impressions  are  assimilated,  and  new 
combinations  of  nerve  elements  made,  the  changes  so 
induced  have  not  the  thoroughness  nor  the  permanence  of 
those  which  take  place  in  early  life.  The  structure  has  lost 
its  plasticity.  The  molecules  are  rearranged  wath  difficulty, 
and  are  apt  to  fall  back  into  their  former  places.  Hence  w^e 
find  that  the  memory  of  recent  events,  which  depends  of 
course  on  recent  changes  in  brain,  is  apt  to  fail.  The 
changes  becoming  easily  effaced,  the  memory,  which  is  their 

21 


3o6  SANITY   AND   INSANITY. 

mental  counterpart,  is  effaced  also.  But  memories  of  events 
which  happened  in  early  life,  and  which  impressed  them- 
selves on  a  plastic  nervous  system,  remain.  That  very 
rigidity  of  structure  which  opposes  the  modification  of  tissue 
by  newly-made  impressions,  tends  to  conserve  the  modifica- 
tions that  were  effected  long  ago  ;  so  that  we  find  that, 
while  memories  of  recent  events  elude  the  mental  grasp  of 
the  old,  memories  of  events  long  past  are  reproduced  with 
all  their  former  vividness,  and  something  more  than  their 
former  frequency. 

These  changes  in  the  mode  of  action  of  the  nervous 
system  have,  of  course,  their  representatives  in  the  modes 
of  mental  action.  The  diminished  activity  of  the  nerve- 
molecules  has  its  bodily  equivalent  in  diminished  energy  of 
movement,  and  its  mental  equivalent  in  diminished  activity 
of  mind.  New  projects  are  not  readily  undertaken,  new 
thoughts  do  not  readily  present  themselves  ;  the  whole 
process  of  thought  is  less  vivid,  less  rapid,  less  active.  As 
with  thought,  so  with  feeling.  In  the  child,  emotions  are 
easily  aroused  and  easily  allayed.  In  the  youth,  the 
emotions  are  predominant,  are  active,  voluminous,  powerful, 
vivid.  As  old  age  advances,  this  part  of  the  nature  also 
becomes  steeped  in  lethargy.  The  affections  wane.  New 
attachments  are  not  formed,  anger  is  not  easily  stirred. 
The  jealousies  and  heartburnings  of  early  life  subside  into 
placidity. 

Such  are  the  concomitants  of  the  onset  of  old  age  in  all 
people.  In  the  great  majority  of  people  a  real  old  age  is 
not  attained.  They  are  cut  off  by  some  quasi-accidental 
malady,  some  fever,  some  inflammation  of  the  lungs,  some 
fibroid  degeneration  of  liver  or  kidney,  before  the  process 
of  life  dies  out  from  sheer  exhaustion.  The  candle  of  their 
life  is  blown  out  or  extinguished,  it  does  not  burn  completely 
away.  It  comparatively  seldom  happens  that  we  get  an 
opportunity  of  witnessing  the  expiry  of  life  from  natural 
decay — from  the  gradual  and  complete  exhaustion  of  that 
impetus  which  the  life  of  the  individual  received  in  the  act 


THE    FORMS    OF    INSANITY.  307 

of  conception,  which  has  carried  it  on,  with  constantly 
diminishing  velocity,  through  the  development  of  childhood 
and  youth,  and  the  activity  of  adult  age,  and  which  must, 
sooner  or  later,  be  brought  to  an  end  by  the  friction  of 
surrounding  circumstances  upon  the  advancing  organism. 
When,  however,  we  do  have  an  opportunity  of  witnessing 
the  advance  of  an  individual  into  an  extreme  old  age,  and 
his  final  decease  from  "  decay  of  nature" — that  is  to  say,  from 
the  exhaustion  of  the  forces  which  have  kept  him  alive — we 
notice  a  uniform  series  of  phenomena.  It  should  here  be 
stated  that  old  age  in  the  sense  here  spoken  of  is  not 
measured  by  years  alone.  One  man  may  die  at  eighty  from 
that  exhaustion  of  his  power  of  living  which  is  here  de- 
scribed, while  another  may  live  on,  hale  and  hearty,  to  ninety, 
or  a  hundred  or  more,  and  then  die  of  inflammation  of 
lungs,  or  some  other  intercurrent  and  quasi-accidental 
malady.  I  speak  now  of  those  only  who  die,  at  whatever 
age,  from  the  complete  expenditure  of  their  vital  impetus. 

When  we  watch  the  closing  years  of  such  a  person,  we 
notice  that  the  signs  of  diminished  activity  and  diminished 
plasticity  of  the  nervous  molecules  are  exhibited  with 
continually  advancing  distinctness,  and  continually  increasing 
emphasis.  We  see  that  the  bodily  activity  steadily  declines, 
the  walks  get  less  and  less  extended,  until  they  are  limited 
to  the  garden,  and  to  an  infrequent  visit  to  a  near  neigh- 
bour ;  then  even  this  amount  of  activity  is  not  reached,  and 
the  old  man  just  gets  about  the  house  and,  when  he  leaves 
it,  has  to  avail  himself  of  the  aid  of  a  bath-chair.  His  bed- 
room is  removed  to  the  ground  floor  because  he  is  no  longer 
capable  of  mounting  the  stairs  ;  he  just  totters  betAveen  his 
bed  and  his  fireside,  and  at  last  is  altogether  bedridden. 

With  this  continuous  decrease  in  the  quantity  of  conduct 
goes  a  continuous  subsidence  in  its  elaborateness.  The 
more  important  parts  of  his  business  have  been  for  some 
time  in  younger  hands.  He  still  lingers  as  long  as  possible 
round  the  scenes  of  his  old  labours,  but  his  actual  part  is 
limited  to  routine  work  ;  and  at  length,  incapable  even  of 


308  SANITY   AND   INSANITY. 

this,  he  retires  altogether.  The  whole  sphere  of  activities 
comprised  in  his  business  relations  is  altogether  relinquished  ; 
the  activities  necessary  for  the  rearing  and  maintenance  of 
offspring  have  long  been  uncalled  for,  his  daughters  being 
married,  and  his  sons  providing  for  themselves.  There 
remain  to  him  only  the  simple  activities  requisite  for  the 
immediate  conservation  of  life,  and  after  a  time  even  these 
are  imperfectly  performed.  His  food  must  be  prepared  for 
him  ;  then  it  has  to  be  cut  up  for  him  ;  and  at  last  he  must 
actually  be  fed.  His  clothes  must  be  ordered  for  him  ;  and 
at  last  he  has  to  be  dressed  and  undressed.  No  longer 
capable  of  conserving  himself  from  the  ordinary  risks  of 
every-day  life,  he  must  be  carefully  watched  and  tended  to 
prevent  some  accidental  circumstance  from  extinguishing 
the  feeble  glimmer  of  life  that  still  remains  to  him. 

Together  with  the  steady  declension  of  conduct,  goes  a 
continuous  declension  of  thought  and  feeling  ;  and  as  with 
conduct,  so  with  mind,  the  most  complex  and  elaborate 
processes  are  the  first  to  fail,  and  the  simplest  and  most 
fundamental  remain  to  the  last.  On  the  more  important 
and  higher  branches  of  his  business,  on  the  general  policy 
of  the  business,  he  exercises  no  influence,  but  he  is  still 
consulted  as  a  matter  of  form  upon  the  general  routine  of 
the  office.  Then,  when  he  retires  altogether  from  business, 
his  children,  or  those  who  have  care  of  him,  consult  him  as 
to  the  disposition  of  the  day,  the  time  of  his  drive,  the  fare 
at  his  dinner,  the  alteration  of  his  garden,  and  so  forth. 
As  his  decadence  progresses,  even  these  simple  matters 
become  beyond  his  capacity  to  decide,  and  he  is  managed 
and  "  done  for "  hke  a  child.  He  is  amused  with  simple 
anecdotes,  but  he  can  give  attention  only  to  the  most  direct 
and  concrete  interests.  He  ^can  appreciate  what  this  man 
said,  and  what  that  man  did,  but  the  movements  and 
opinions  of  masses  of  men  are  beyond  his  capacity  to 
comprehend.  The  peculiar  defect  of  memory  we  have 
already  considered.  At  length  a  time  comes  when  he  ceases 
to  interest  himself  in  anything  save  the  simplest  and  most 


THE    FORMS   OF    INSANITY.  309 

concrete  matters.  He  appreciates  that  his  food  is  not  ready 
when  he  wants  it,  and  his  daughter's  absence  from  his  room 
is  a  trouble  to  him  ;  but  beyond  this  he  does  not  interest 
himself.  His  own  condition  and  inclinations  may  be  dis- 
cussed in  his  OAvn  presence  without  arousing  his  inteUigence 
or  attention  about  the  matter. 

The  decadence  of  feeling  iprocQedSjpari  passu,  with  that 
of  conduct  and  intelligence.  When  an  old  man's  ^other 
faculties  begin  to  fail,  he  becomes  incapable  of  feelings  of  a 
high  degree  of  elevation.  On  the  occurrence  of  a  cause 
ceUbre  he  fails  to  rise  to  the  feeling  of  justice,  but  takes  the 
feminine  view  that  it  would  be  cruel  to  punish  the  offender. 
He  loses  his  appreciation  of  humour,  and  it  needs  the  coarse 
stimulus  of  broad  farce  to  arouse  his  sense  of  the  ridiculous. 
As  his  decadence  proceeds,  he  ceases  to  feel  sympathy  with 
the  sufferings  of  others,  his  anger  degenerates  into  peevish- 
ness and  fretfulness  ;  occasions  of  grief,  the  loss  of  near 
relatives,  move  him  only  to  slight  and  transient  sorrow. 
Finally,  even  the  more  rudimentary  feelings  fade  away,  and 
he  sits  huddled  in  his  chair  doing  nothing,  noticing  nothing, 
feeling  virtually  nothing. 

The  failure  of  action  in  old  age  is,  however,  not  only  in 
the  nervous  system.  While  the  brain  has  been  growing 
old,  the  rest  of  the  body  has  not  remained  young.  The 
altered  structure  of  the  bones  has  already  been  referred  to, 
and  corresponding  changes  take  place  in  every  tissue.  What 
remains  of  the  hair  turns  grey  ;  the  skin  is  withered  and 
wrinkled  ;  the  arciis  senilis  appears  in  the  eye  ;  the  muscles 
waste  ;  all  the  viscera,  every  part  of  the  body  alters,  and 
alters  not  only  in  structure,  but  in  the  activity,  and  in  the 
very  nature  of  the  processes  that  takes  place  in  it.  We  have 
already  seen  that  the  activity  and  the  nature  of  the  pro- 
cesses that  go  on  throughout  the  body,  give  rise  to  a  con- 
tinuous set  of  voluminous  nerve  currents  which  flow 
upwards  and  break  upon  the  shore  of  the  highest  nerve 
regions,  whose  action  is  influenced,  modified,  and  coloured 
by  their  agency.      The  existence  and  the  nature  of  these 


310  SANITY   AND   INSANITY. 

currents  has,  as  we  have  seen,  a  reflexion  in  the  mental 
state.  Upon  them  depends  the  character  and  permanence 
of  the  subject-consciousness,  of  the  consciousness  of  self,  of 
personal  identity.  When  these  currents  become  changed, 
as,  upon  alteration  of  the  processes  which  initiate  them,  they 
must  do,  the  consciousness  of  self  must  and  does  change;  and 
when  the  currents  alter  in  intensity,  the  feeling  of  well- 
being  undergoes  alteration.  Hence  it  is  that  as  the  body  grows 
old,  the  individual  feels  aged  ;  not  by  deliberately  counting 
up  the  years  that  he  has  lived,  but  by  the  mirrored  repre- 
sentation in  consciousness  of  the  changes  that  the  body  has 
undergone.  Hence,  as  the  body  changes  by  addition  or 
subtraction  of  functions,  as  at  puberty  and  the  menopause, 
so  the  individual  changes  by  the  addition  or  abstraction  of 
faculties — of  elements  of  character.  Hence  a  high  state  of 
vigour  in  the  nutrition  of  the  body  is  mirrored  in  buoyancy 
of  spirits,  and  imperfect  tissue  changes  in  mental  depression. 
In  the  dementia  of  old  age,  the  vigour  of  the  nutritive 
processes  is  greatly  slackened  and  diminished,  and  hence  in 
this  condition  buoyant  and  abounding  spirits  are  unknown. 
As,  however,  the  slackening  of  the  nutritive  processes,  and 
therefore  of  the  viscerally  derived  nerve  currents,  is  in 
proportion  to  the  general  diminution  of  activity  of  the 
entire  nervous  system,  the  diminution  of  the  sense  of  well- 
being  is  not  out  of  proportion  to  the  actual  diminution  of 
the  bodily  energies,  and  amounts  merely  to  a  placid  absence 
of  high  spirits  rather  than  to  any  actual  feeling  of  depression. 
Apart  from  the  alteration  in  activity,  the  change  in  the 
nature  of  the  nutritive  processes  is  such,  that  in  consciousness 
of  self  the  old  man  is  a  different  being  from  the  young  one. 
Circumstances,  in  themselves  the  same,  impress  him  diffe- 
rently, as  explained  in  a  previous  chapter. 

From  beginning  to  end  the  process  is  a  continuous, 
gradually  progressing  loss.  Conduct,  intelligence,  feeling, 
and  self-consciousness  gradually  diminish,  and  at  last 
cease  to  exist  ;  the  loss  afTecting,  first  and  most,  the  highest 
faculties,  and  leaving  till  the  last  those  that  are  simplest, 


THE    FORMS   OF    INSANITY.  3II 

lowest,  and  most  fundamental.  The  decadence  of  old  age 
is,  in  fact,  a  dementia^  a  deprivation  of  mind.  It  is  a  normal 
and  physiological  dementia,  the  natural  and  inevitable  result 
of  the  gradual  subsidence  of  the  molecular  movements  of 
the  nervous  elements  into  stillness  ;  the  natural  outcome  of 
the  exhaustion  of  the  initial  impetus  which  started  the 
organism  upon  its  course  of  life  and  kept  it  going  ;  the 
natural  expression  of  that  dissipation  of  energy  which 
accompanies  the  integration  of  matter  in  the  process  of 
evolution.  It  is  by  this  gradual  subsidence  to  rest  of  the 
process  of  storing  and  expending  energy,  that  life  tends  to 
terminate.  The  prolongation  of  the  average  length  of  life, 
that  has  taken  place  with  advancing  civilization  and  sani- 
tation, has  not  resulted  from  any  perceptible  increase  in  the 
vigour  and  staying  power  of  the  human  race.  It  has  re- 
sulted from  the  diminution  of  the  causes  of  intercurrent 
maladies  which  tend  to  cut  life  short  before  its  initial 
impetus  has  been  wholly  expended.  By  this  lessening  of 
the  causes  of  intercurrent  maladies  ;  by  the  greater  skill 
that  they  are  dealt  with  ;  and  by  the  greater  and  more 
intelligent  care  with  which  the  later  stages  of  man's  career 
are  nursed,  and  his  friction  with  circumstances  diminished  ; 
it  has  resulted  that  more  individuals  survive  to  the  extreme 
end  of  their  career,  and  that  those  who  are  cut  off  before 
the  vital  energy  wholly  fails,  reach,  on  the  average,  a  later 
stage  before  they  succumb,  than  was  formerly  the  case.  But 
however  perfect  our  sanitation  may  become,  and  however 
careful  a  valetudinarian  race  may  be  of  the  air  they  breathe, 
the  water  they  drink,  the  clothing  they  wear,  the  amount  of 
exercise  they  take,  of  the  thousand-and-one  things  that  the 
lugubrious  prophets  of  health  enjoin  or  forbid  them  to  do, 
the  effect  upon  the  natural  termination  of  life  by  lapse  of 
energy,  as  distinguished  from  its  artificial  termination  by 
disease,  will  be  inappreciable.  If,  indeed,  long-lived 
families  were  carefully  chosen  and  bred  together  under 
favourable  conditions,  there  is  no  reason  Avhy  in  time  a 
longer-lived  race  of  men  should  not  be  created  ;  but  there 


312  SANITY    AND    INSANITY. 

appears  no  prospect  of  such  a  process  being  started  at 
present,  and  for  generations  to  come  we  shall  have  to  be 
content  with  a  duration  of  natural  life  approximating  to  that 
which  now  obtains,  with,  it  may  be,  some  slight  increase  due 
to  the  healthier  and  more  vigorous  condition  that  wiser 
ways  of  living  may  induce,  in  the  generality  of  parents,  up 
to  the  time  of  procreation. 

We  have  traced  the  organism  from  the  time  of  conception, 
when  it  receives  the  original  impetus  to  which  its  existence 
is  due,  through  the  course  of  its  growth  and  development, 
to  the  condition  of  maturity  ;  and  then  through  its  decline 
into  quiescence  as  the  original  impetus  becomes  spent.  We 
have  yet  to  notice  the  final  scene  of  all,  and  to  observe  the 
way  in  which  the  ultimate  failure  of  energy  brings  about  the 
subsidence  from  dementia  into  death. 

It  has  been  shown  hoAV  the  higher  faculties  are  the  first 
to  fail,  and  how  they  fail  most  completely  while  the  lower 
faculties  still  retain  some  degree  of  efficiency.  If  we  imagine 
this  process  of  degradation  carried  to  extremity,  we  shall 
find  a  state  of  things  in  which  the  whole  of  the  higher 
faculties  are  lost,  and  nothing  remains  but  the  lowest  and 
most  fundamental  of  all.  Such  a  state  of  things  exists  in 
the  condition  known  as  coma.  In  coma  there  is  deep  in- 
sensibility. The  patient  lies  motionless.  Conduct  is  alto- 
gether abolished.  There  can  be  no  conduct,  for  there  is  no 
movement.  There  is  no  movement  because  the  whole  body 
is  more  or  less  paralyzed.  The  paralysis  of  the  body  is  due 
to  the  loss  of  function,  not  only  of  the  highest  layers  of 
nervous  arrangements,  but  of  the  middle  and  part  of  the 
lower  layers  also.  The  process  of  degradation  has  proceeded 
very  far.  Conduct  is  abolished  ;  voluntary  movement  is 
abolished  ;  only  the  most  fundamental  movements  of  all — 
those  of  the  heart  and  of  the  breathing — remain  ;  and  even 
these  are  altered. 

Since  conduct  and  voluntary  movement  are  abolished 
by  the  abolition  of  function  of  the  higher  and  middle 
nervous  arrangements,  of  course  feeling  and  thought,  which 


THE   FORMS   OF    INSANITY.  313 

are  the  accompaniments  of  the  action  of  these  arrange- 
ments, are  lost  also.  In  coma  the  whole  man  is  paralyzed  ; 
he  is  also  insensible.  Speak  to  him  and  he  does  not  answer  ; 
shake  him  and  he  makes  no  response.  Hold  a  bright  light 
to  his  eye  and  he  does  not  wink  ;  pinch  or  prick  his  skin 
and  he  does  not  retaliate,  nor  even  withdraw  his  limb.  The 
loss  of  function  has  extended  almost  to  the  lowest  strata  of 
the  nervous  system  ;  those  functions  only  remain  which  are 
essential  to  the  mere  preservation  of  life.  Such  is  the  con- 
dition of  a  man  who  is  stunned  by  a  severe  blow  on  the 
head  ;  such  the  state  of  a  man  whose  brain  is  compressed 
by  the  bursting  of  a  blood-vessel  inside  his  skull ;  and  such 
is  the  condition  of  a  man  who  is  in  the  very  last  stage  of  a 
life  that  is  expiring  from  failure  of  the  energy  necessary  to 
to  carry  it  on.  If  the  process  of  degradation  is  carried  but 
one  step  .further,  if  the  abolition  of  function  proceeds  so  as  to 
affect  those  processes  that  still  remain  ;  the  nervous  apparatus 
that  actuate  the  movements  of  breathing  and  the  move- 
ments of  the  heart  become  still  more  affected,  the  breathing 
gets  more  and  more  embarrassed,  the  intervals  betAveen  the 
several  acts  of  inspiration  become  longer  and  longer,  until 
at  last  the  breathing  ceases  altogether,  and  the  heart,  after 
vainly  struggling  for  a  time  to  carry  on  its  function  with 
unaerated  blood,  also  ceases  to  act,  and  death  ensues. 
Such  is  the  natural  termination  of  life ;  the  termination  that 
all  would  suffer  were  it  not  for  the  intervention  of  sotrq 
inflammation  or  other  positive  malady,  which,  in  the  great 
majority  of  cases,  cuts  men  off  before  their  sands  have  com- 
pletely run  out.  Such  _is  the  natural  termination  of  the 
dementia  of  old  age. 

It  now  remains  to  examine  the  third  occasion  in  which 
insanity  occurs  in  the  normal  organism — the  insanity  that 
is  due  to  alcoholic  intoxication.  It  has  been  shown  how  the 
alcohol  that  is  taken  into  the  stomach  is  absorbed  into  the 
blood,  and  carried  by  it  into  actual  contact  with  the  nerve 
elements,  upon  which  it  acts  as  a  direct  stress  of  very  urgent 
and  powerful  character. 


3 14  SANITY   AND   INSANITY. 

It  must  be  understood  that,  in  "'speaking  of  alcoholic 
intoxication  as  a  form  of  insanity,  the  expression  is  not 
used  as  a  figure  of  speech  :  it  is  strictly  and  literally 
true  that  when,  and  in  so  far  as,  a  man  is  intoxicated 
by  alcohol,  then  and  to  that  extent  he  is  insane.  Seeing 
that  the  cause  is  so  obvious,  the  condition  so  temporary, 
and  that  the  manifestations  of  the  insanity  as  a  rule 
differ  somewhat  from  those  in  insanity  due  to  other  causes, 
and  have  a  general  resemblance  to  other  cases  due  to  the 
same  cause,  the  insanity  due  to  acute  alcoholic  poisoning 
is  not  usually  looked  upon  as  insanity.  It  is  called  by  a 
different  name,  and  is  considered  a  different  thing  ;  but  in 
essential  nature  the  two  are  identical.  If  a  man  disorders 
his  higher  nerve  functions  by  a  few  doses  of  alcohol  taken 
at  dinner,  and  appears  after  dinner  to  be  in  liquor ;  if,  under 
these  circumstances,  he  becomes  uproarious  and  commits  an 
unprovoked  assault,  he  is  looked  upon,  not  as  being  insane, 
but  as  being  drunk.  But  if,  after  a  prolonged  course  of 
drinking  extending  over  years,  he  becomes  habitually  up- 
roarious, and  habitually  prone  to  commit  unprovoked  assaults, 
he  is  looked  upon,  not  as  being  drunk,  but  as  being  insane. 
Usually,  drunkenness  is  distinguished  from  other  instances 
of  insanity  by  the  peculiar  character  of  the  mental  condition, 
which  we  call  "  elevated,"  and  by  the  bodily  defects  which 
go  with  it — by  the  thickness  of  speech,  the  reeling  gait,  the 
clumsy  and  inefficient  movements  of  the  hands.  But,  in 
the  first  place,  there  is  a  form  of  permanent  insanity — 
general  paralysis  of  the  insane — with  which  we  shall  pre- 
sently have  to  deal,  which  exhibits,  not  only  precisely  the 
same  kind  of  elevation  of  mind,  but  precisely  the  same 
thickness  of  articulation,  the  same  reel  in  the  gait,  the  same 
clumsy  inefficiency  of  the  digital  movements,  that  charac- 
terize ordinary  drunkenness  ;  and  in  the  second  place  these 
characteristics  are  by  no  means  invariably  present  in  the 
insanity  of  drunkenness  itself.  When  the  drunken  man 
is  a  man  of  ordinarily  strong  and  stable  constitution,  the 
manifestations  of  drunkenness  take  the  ordinary  form  ;  but 


THE   FORMS   OF   INSANITY.  3l5 

when  a  man  who  inherits  an  undue  instability  of  nerve 
tissue  gets  drunk,  the  manifestations  are  very  different.  In 
such  a  case  the  bodily  defects  of  articulation  and  gait  may 
be  wholly  absent.  Not  a  trace  of  unsteadiness  or  hesitation 
may  be  observable  ;  and,  on  the  other  hand,  the  disorder 
of  conduct  may  amount  to  a  violent  outbreak  of  maniacal 
delirium  ;  so  that  the  drunkard,  instead  of  reeling  home 
in  a  state  of  maudlin  besottedness,  raves,  screams,  smashes 
the  furniture,  strips  himself  naked,  jumps  through  the 
window,  murders,  or  tries  to  murder,  an  inoffensive  by- 
stander, and  is  taken  to  a  lunatic  asylum  as  a  dangerous 
maniac,  which  he  is.  In  the  course  of  a  few  hours,  the 
alcohol  is  disintegrated  and  passes  out  of  the  system,  the 
higher  nerve  regions  resume  their  function,  the  drunkard 
becomes  sober,  and  it  becomes  difficult  to  believe  that  the 
quiet,  rational  being  of  this  morning  was  the  furious  maniac 
of  last  night.  Such  cases  are  not  very  uncommon,  and  few 
persons  who  have  had  asylum  experience  have  failed  to  see 
them.  If  persons  whom  drink  affects  in  this  way  are  wise, 
and  have  sufficient  self-control,  they  entirely  abjure  the  use 
of  alcohol  after  an  experience  of  this  kind,  and  so  long  as 
they  keep  from  it  they  are  useful  members  of  society.  If, 
however,  they  are  deficient  in  determination,  and  cannot 
keep  from  the  bottle,  they  pass  their  lives  going  in  and  out 
of  lunatic  asylums.  Every  drunken  debauch  constitutes 
such  a  man  a  maniac  ;  he  is  taken  to  an  asylum,  and  in 
a  few  days  his  enforced  abstinence  from  drink  cures  him 
of  his  insanity.  Being  sane,  he  is  discharged,  and  in  a  few 
weeks  he  is  back  again  with  all  his  old  symptoms  upon  him. 
However  the  manifestations  of  drunkenness  may  vary  in 
different  cases,  Ave  still  find  that,  in  all  cases,  the  action  of 
alcohol  on  the  nervous  system  follows  the  same  law  that 
has  been  so  often  stated.  It  abolishes  the  function  of  the 
nerve  regions  in  the  order  of  their  succession  from  above 
downwards.  The  highest  suffer  first  and  most,  the  lowest 
last  and  least.  Let  us  trace  the  course  of  an  ordinary  case, 
and  note  the  completeness  with  which  this  law  is  observed, 


3l6  SANITY   AND   INSANITY, 

as   evidenced   by  the  parallel   and  simultaneous   failure  of 
conduct  and  mind. 

Ask  a  man  who  has  just  left  a  city  dinner  to  settle  with 
you  the  lease  of  a  house,  or  a  deed  of  partnership.     He  will 
naturally  refuse.     If  you  press  him,  he  will  say  that  it  is  not 
a  proper  time  to  transact  business  ;  and,  if  pressed  further, 
will  explain  that  to  take  him  now  is   unfair,  for  to  such 
an  important   and  delicate  matter  one  must  come  with  a 
clear  head.     The  admission  is  that   the  mind   is  not  now 
as  vigorous  as  it  will  be  to-morrow  morning.     There  is  a 
slight  enfeeblement.     Partly  from    the  fatigue  of  the  day, 
partly  from  the  effect  of  the  dinner  in  drafting  off  a  part 
of   the  blood-supply  from  the  brain    to  the  stomach,  but 
chiefly  from  the  benumbing  effect  of  the  alcohol  that  he  has 
imbibed  on  his  highest  nerve  regions,   his  mind  is  not  as 
clear  nor  as  vigorous  as  it  is  wont  to  be.     The  confusion 
is  not  great,  he  can  make  an  after-dinner  speech  of  average 
intelligence,  can  reckon  his  legal  cab  fare,  and  so  forth,  but 
he  will    not    trust    himself  to  settle  a    delicate    matter   of 
negotiation.     He  feels  that  the  keen  edge  of  his  intellect 
is    blunted.     It    is  the  very  highest  of  all   his  intellectual 
faculties  that   have  been  dulled.     Similarly  on  the  bodily 
side — he  can  walk  perfectly  straight,  can  light  a  cigar  with- 
out bungling,  and  button  his  ^overcoat  with   facility  ;    but 
when  he  tries  to  play  billiards  he  finds  "  his  hand  is  out." 
He  is  not  certain  of  his  strokes.     He  can  no  longer  regulate 
his  movements  with  the  nice  precision  that  is  required  for 
success.     Of  bodily,  as  of  mental  capabilities,  he  has  lost  the 
most  elaborate,  the  most  delicate,  the  most  precise.     At  the 
same  time  that  he  shows  these  signs  of  defect  in  his  highest 
nerve    arrangements,    he    shows   some    sign    of  over-action 
of   somewhat    lower  arrangements.     By  the  annulling  and 
placing  out  of  action  of  the  highest,  control  is  removed  from 
those  just  below  the  highest,  which  are  consequently  "  let 
go  "  and  tend  to  over-act.     The  staid  and  self-enclosed  man 
of   business    becomes   an  expansive,  jolly  companion.     He 
gets  on    back-slapping,  rib-punching    terms  with    his  con- 


THE    FORMS   OF    INSANITY.  317 

vives.  He  tells  little  anecdotes  about  his  past  career,  with 
winks,  and  wheezes,  and  warnings  that  they  are  not  to  be 
repeated  to  his  wife.  His  discretion  and  reticence  are 
diminished  by  the  loss  of  his  highest  centres,  and  he 
exhibits  a  phase  of  character  inferior  to  his  usual  standard. 
No  one  would  call  this  state  of  things  insanity  ;  but  for  all 
that  it  is  the  beginning  of  a  process  which,  if  continued, 
would  become  insanity.  It  is  the  point  at  which  divergence 
from  the  processes  of  health  begins  to  occur.  It  is  not 
insanity,  but  it  is  the  rudiment  of  insanity.  Let  us  trace 
the  process  further  and  see  what  it  develops  into. 

Let  us  suppose  that  the  toper  has  taken  distinctly  more 
than  is  good  for  him  ;  that  instead  of  the  thin  film  taken  off 
his  highest  centres,  a  paring  of  appreciable  thickness  has  had 
its  function  removed  by  the  alcohol.  The  consequence  of 
this  loss  is  that  his  conduct  becomes  more  conspicuously 
defective.  He  is  excited  into  a  quarrel  by  a  provocation 
which  would  have  no  such  effect  on  him  in  his  normal  con- 
dition, and  he  conducts  the  quarrel  in  an  unseemly  manner. 
He  uses  language  which  he  would  never  permit  himself 
to  use  when  sober,  and  displays  his  passion  before  strangers 
and  servants  in  a  w^ay  that  would  horrify  him  at  other 
times.  Here  there  is,  on  the  one  hand,  deficient  regard 
of  his  surroundings,  and  deficient  control,  due  to  the  removal 
of  his  highest  faculties  ;  and,  on  the  other  hand,  there  is 
the  positive  excess  of  action,  the  violent  language,  and  so 
forth,  which  is  due  to  the  over-action  of  the  centres  below 
the  highest,  which  are  now  uncontrolled  in  their  action. 
With  this  disorder  of  conduct  go  parallel  disorders  of  mind. 
His  higher  feelings  of  decorum  and  self-respect  are  weakened 
or  lost,  and  his  lower  feelings  of  anger  and  resentment  are 
present  in  excess.  His  appreciation  of  the  regard  and  respect 
of  his  companions  is  diminished,  and  his  appreciation  of  the 
provocation  he  has  received  is  exaggerated. 

At  this  stage  is  introduced  a  new  phenomenon.  It  has 
been  shown  that  the  highest  centres  suffer  first  and 
most  ;   and   at  this  stage  the  highest  layers  of  the  highest 


31 8  SANITY   AND   INSANITY. 

regions  are  those  which  suffer  most  ;  but  they  are  not  the 
sole  sufferers.  Besides  the  failure  in  conduct,  which  is  due 
to  failure  in  the  highest  regions,  there  is  a  failure  in  the 
apparatus  by  which  conduct  is  executed.  Not  only  has  the 
driver  lost  his  way,  but  the  horse  is  lame  also.  The  motor 
apparatus  which  carries  out  the  directions  of  the  highest 
centres  through  the  intermediation  of  the  inferior  centres, 
is  acting  imperfectly.  The  articulation  is  thick  and  hesi- 
tating ;  the  movements  of  the  hands  are  shaky  and  uncertain  ; 
the  gait  is  unsteady.  In  other  words,  not  only  are  the 
highest  centres  affected,  but  the  middle  group  are  affected 
also  ;  and  in  this  group  the  same  law  still  holds  good  ;  that 
is  to  say,  when  the  middle  regions  become  affected  the 
highest  portions  of  them  are  the  first  to  go.  The  move- 
ments of  articulation,  which  are  the  most  precise,  delicate, 
elaborate,  and  complex,  suffer  first  and  most  ;  those  of  the 
hands  next  ;  and  those  of  locomotion  last.  Within  each 
of  these  minor  groups  the  same  law  holds  good  ;  the  dis- 
tinct enunciation  of  syllables  is  lost  before  the  varied  cadence, 
and  the  variations  of  cadence  sink  into  uniformity  before 
the  voice  is  altogether  lost. 

At  this  stage,  or  at  a  stage  a  little  in  advance  of  this,  the 
insanity  of  the  toper  is  no  longer  in  doubt.  Suppose  that 
instead  of  the  evening  it  were  the  morning  ;  suppose  that 
the  previous  indulgence  in  alcohol  were  not  known  and 
were  not  recognizable  ;  suppose  that  the  condition,  instead 
of  being  temporary,  were  permanent  ;  what  would  be  said 
of  a  respectable  merchant  who  should  quarrel  violently  with 
a  chance  acquaintance  upon  insignificant  provocation,  and 
who,  in  the  presence  of  strangers  and  servants,  offered  to  take 
off  his  coat  and  fight  ?  What  would  be  said  if  he  remained 
for  several  days  or  weeks  in  this  condition,  now  maudlin, 
now  quarrelsome,  incapable  of  understanding  or  conducting 
the  affairs  of  his  business,  and  disgracing  his  family  by  his 
conduct  ?  Would  not  his  friends  consider  that  beyond  all 
question  the  man  was  insane  ?  Would  not  they  take  steps 
to  restrain  him  from  putting  himself  outside  the  law,  and 


THE    FORMS    OF    INSANITY.  3 19 

damaging  his  business  ?  Unquestionably  they  would.  And 
if  this  condition  is  one  of  insanity  when  prolonged  and  pro- 
ceeding from  no  obvious  cause,  none  the  less  is  it  one 
of  insanity  so  long  as  it  lasts,  when  it  is  of  brief  duration, 
and  when  a  manifest  cause  can  be  assigned  for  it.  The 
causation  and  duration  do  not  affect  the  nature  of  the 
malady,  however  much  they  may  determine  its  gravity. 
The  insanity  may  be  the  transient  insanity  of  drunkenness 
or  the  permanent  insanity  of  general  paralysis  ;  but  if  the 
manifestations  of  drunkenness  are  identical  with  those  of 
insanity,  it  cannot  be  denied  that  the  drunkard,  so  long 
as  he  is  drunk,  is  mad. 

That  the  resemblance  of  the  manifestations  of  drunken- 
ness to  those  of  insanity  means  a  real  identity  in  nature 
between  the  two  conditions,  and  is  not  merely  a  far-fetched 
analogical  resemblance,  is  shown  by  two  circumstances  :  first, 
that  there  is  a  Avell-marked  and  distinct  variety  of  insanity 
which  reproduces  with  minute  faithfulness  the  characteristic 
signs  that  ordinary  cases  of  drunkenness  display  ;  and 
second,  that  every  form  of  insanity  is  reproduced  with  accu- 
rate simulation  by  some  case  of  drunkenness.  Although, 
in  nineteen  cases  out  of  twenty,  the  drunkard  is  jovial, 
noisy,  restless,  stuttering,  and  unsteady,  we  have  already 
seen  that  in  a  certain  proportion  of  cases  he  manifests  no 
thickness  of  articulation,  and  no  unsteadiness  of  hands  or 
legs,  but  exhibits  a  maniacal  fury.  We  have  now  to  record 
that  this  is  but  one  of  the  unusual  manifestations  of  drunken- 
ness. In  others  of  these  atypical  cases,  the  drunkard  is 
sullen,  morose,  suspicious,  and  revengeful.  In  others  he  is 
subject  to  delusions  of  various  kinds.  In  others  he  has 
definite  hallucinations  ;  he  hears  voices  commanding  him  to 
certain  acts  ;  he  sees  spectral  forms  of  men  or  animals  about 
him.  There  is  no  form  of  insanity  that  may  not  be  simu- 
lated by  a  case  of  drunkenness  ;  and  when  it  is  not  knoAvn, 
from  other  sources  of  information,  that  these  manifestations 
are  due  to  drink,  no  expert  in  the  world,  however  skilful, 
could    distinguish   between    the    insanity   that    is    due   to 


320  SANITY   AND   INSANITY. 

alcoholic  poisoning  and  the  insanity  that  is  due  to  other 
causes. 

As  if  to  place  the  matter  beyond  all  sort  of  doubt,  it 
occasionally  happens  that  the  effects  of  a  drunken  debauch 
do  not  pass  away  in  a  few  hours  or  days,  but  persist  for 
weeks.  In  such  a  case  the  manifestations  are  usually  different 
from  those  of  ordinary  cases  of  drunkenness,  and  resemble 
those  of  other  cases  of  mania  ;  and  in  such  cases  the  patient 
very  often  finds  his  way  into  a  lunatic  asylum,  where  he  is 
recorded  and  treated  as  a  case  of  "  insanity  caused  by  drink." 
When  the  drunken  debauches  have  been  frequent  and  long- 
continued,  the  condition  of  insanity  becomes  permanent, 
and  remains  after  the  drink  has  long  been  discontinued.  In 
such  cases  the  transition  from  the  insanity  of  drunkenness 
to  ordinary  insanity  is  complete. 

Finally,  the  last  stage  of  drunkenness  and  the  last  stage 
of  insanity  are  identical  and  indistinguishable.  We  have 
seen  that  the  natural  termination  of  life  is  by  coma.  The 
progressive  loss  of  all  the  higher  nerve  functions  leaves  at 
length  none  but  those  which  actuate  the  breathing  and  the 
circulation.  Then  a  continuation  of  the  same  degradative 
process  stills  the  breathing  ;  the  circulation  fails,  and  the  result 
is  death.  Such  is  the  natural  termination  of  the  dementia  of 
old  age,  and  such  also  is  the  natural  termination  of  other 
cases  of  dementia — of  every  case  of  insanity.  All  insane 
people,  who  die  of  their  insanity,  and  not  of  any  intercurrent 
disease,  die  by  coma.  Such  also  is  the  termination  of  every 
case  of  drunkenness.  It  is  well  known  that  if  a  man  goes 
on  drinking  after  he  has  had  enough  and  more  than  enough, 
he  will  at  length  drink  himself  into  a  state  of  insensibility  ; 
he  will  at  length  fall  on  the  floor,  and  lie  there  snoring  and 
incapable  of  being  aroused.  He  is  said  to  be  asleep,  but  if 
he  be  examined  it  will  be  found  that  he  is  not  in  ordinary 
sleep,  but  in  coma.  He  cannot  be  aroused  ;  his  limbs  are 
paralyzed  ;  his  breathing,  his  heart's  action,  the  condition  of 
his  skin,  his  eyes,  &c.,  are  those  of  a  person  in  coma.  From 
this  condition  he  usually  recovers  ;  but  he  does  not  always 


THE   FORiMS   OF    INSANITY.  321 

recover.  Cases  occur  ;from  time  to  time  in  which  a  man 
passes  from  the  sleep  of  drunkenness  to  the  sleep  of  death. 
Such  an  event  is  a  not  infrequent  result  of  "sucking  the 
monkey."^  The  dose  of  poison  that  he  has  taken  is  found 
to  be  enough  to  paralyze,  not  merely  his  highest  nerve 
region,  not  merely  the  highest  and  middle,  but  to  still  the 
action  even  of  the  lowest,  the  most  obdurate,  and  the  least 
obnoxious  to  the  influence  of  the  drug.  Thus,  from  beginning 
to  end,  a  case  of  drunkenness  is  a  case  of  insanity. 

There  are,  therefore,  three  ways  in  which  the  normal  and 
healthy  organism  undergoes  a  decadence  of  conduct  and 
mind  amounting  to  insanity  :  in  the  natural  obliteration  of 
nervous  function  that  occurs  in  sleep  ;  in  the  natural  and 
more  prolonged  obliteration  that  occurs  in  old  age  ;  and  in 
the  obliteration  artificially  produced  by  the  action  of  alcohol 
and  other  narcotic  drugs.  Seeing  that  in  these  three  Avays 
the  mind  and  conduct  naturally  tend  to  err,  and  bearing  in 
mind  the  principle  that  all  abnormal  states  are  but  exaggera- 
tions of  the  normal,  it  is  not  unlikely  that  the  main  forms 
of  insanity  might  be  founded  on — might  be  the  abnormal 
counterparts  of — these  natural  modes  of  decadence.  Failure 
of  function  will  naturally  tend  to  follow  the  course  which 
it  has  been  accustomed  to  follow.  If  there  are  definite  ways 
in  which  the  nervous  system  is  accustomed  to  fail  under 
normal  stresses,  these  will  be  the  ways  in  which  it  will  tend 
to  fail  under  abnormal  stresses.  The  failure  will  be  more 
complete  as  the  stresses  are  more  intense  ;  but  the  starting- 
point  and  direction  of  the  failure  will  be  alike  in  the  two 
cases.  A  prolonged  and  extensive  study  of  insanity  shows 
that  the  ways  in  which  the  functions  of  the  nervous  system 
fail  in  that  disorder,  do  resemble,  in  the  main,  the  several 
ways  in  which  it  fails  physiologically. 

It  will  have  been  noticed  that  each  of  the  several  physio- 
logical forms  of  insanity  has  its  distinguishing  peculiarities. 
The  dementia  of  old  age,  which  is  the  type  and  example  of 

^  This  term  is  applied  to  a  practice  pursued  by  dock  labourers,  of  boring 
a  gimlet-hole  in  a  cask  of  spirits  and  applying  the  lips  to  the  orifice. 

22 


322  SANITY   AND    INSANITY. 

all  insanities,  is  distinguished  by  the  equable^  proportional^ 
and  gradual  failure  of  every  portion  of  the  nervous  system. 
The  failure  of  the  highest  regions  is  most  conspicuous  and 
prominent,  it  is  true  ;  but  while  the  highest  regions  are  fail- 
ing, the  middle  and  lower  regions  are  also  failing  to  an 
extent,  which,  while  not  the  saniedci  the  failure  of  the  highest 
regions,  is  strictly  in  proportion  to  their  failure  ;  that  is  to 
say,  in  proportion  as  the  highest  regions  lose  their  power  of 
initiating  forms  of  conduct,  the  middle  regions  lose  their 
power  of  initiating  forms  of  movement,  and  the  lowest 
regions  lose  their  power  of  maintaining  the  nutritive  pro- 
cesses. Pari  passu  with  the  diminution  in  the  vividness 
and  comprehensiveness  of  the  knowledge  and  appreciation 
of  surroundings,  occurs  a  diminution  in  the  vividness  and 
completeness  of  the  consciousness  of  self.  All  the  faculties, 
both  of  mind  and  body,  decay  regularly,  equably,  and  pro- 
portionally to  one  another,  and  the  decay  is  gradual  and 
uniform  in  its  progress.  Feeling,  intelligence,  self-conscious- 
ness, conduct,  movement,  and  nutrition,  undergo  gradual, 
simultaneous,  and  proportional  diminution. 

In  the  other  forms  of  physiological  dementia  this  equable, 
proportional  and  gradual  form  of  the  process  is  departed 
from  ;  and  the  several  varieties  that  they  present  depend 
upon  the  amount  of  the  departure  from  the  regular  course, 
and  on  the  element  in  that  course  in  Avhich  the  departure 
takes  place.  Thus,  when  the  defect  presses  with  dispropor- 
tional  intensity  upon  the  visceral  moiety  of  the  nervous 
system,  there  is  alteration  in  the  consciousness  of  self,  which 
is  out  of  proportion  to  the  alteration  in  the  consciousness  of 
surroundings.  Then  the  leading  manifestation  of  the  in- 
sanity is  a  condition  of  melancholia  or  mental  depression, 
accompanied  by  a  torpor  in  the  bodily  processes.  When  the 
defect  weighs  with  greater  intensity  on  the  other  moiety  of 
the  nervous  system,  there  is  a  condition  of  dementia  without 
a  proportional  diminution  or  depression  of  self-conscious- 
ness. 

We  have  already  seen  (Chap.  III.)  that  consciousness  con- 


THK    FORMS    OF    INSANITY.  323 

sists  of  two  parts.  One,  the  coensesthesis,  or  consciousness 
of  self,  is  the  reflection,  in  the  mirror  of  the  mind,  of  the  pro- 
cesses set  up  in  the  higher  nerve  regions  by  nerve  currents 
originating  in  the  interior  of  the  body,  currents  which  are 
started  by  the  molecular  movements  of  the  process  of  nu- 
trition, and  which  are  vigorous  or  feeble,  voluminous  or 
attenuated,  as  nutrition  is  active  or  languid.  Some  part  of 
this  upward  flow  of  nerve  energy  comes  from  the  muscles, 
whose  bulk  is  great,  but  whose  nutritive  changes  are  compara- 
tively same  and  uniform,  and  do  not,  therefore,  offer  con- 
ditions very  favourable  to  the  production  of  energetic  nerve 
stimulation.  The  great  bulk  of  the  internally  originated 
nerve  currents  are  derived  from  the  viscera,  and  especially 
the  abdominal  viscera,  whose  immense  surfaces,  whose 
copious  nerve  supply,  whose  great  variety  of  function,  and 
whose  wide  and  rapid  fluctuations  of  activity,  render  them 
especially  apt  to  give  rise  to  voluminous  and  energetic  nerve 
currents.  The  coenaesthesis,  the  "  conscious  ego,"  the  con- 
sciousness of  a  pervading  and  abiding  self,  which  underlies, 
forms  the  background  of,  and  gives  colour  to,  the  conspicuous 
and  definite  changes  which  occupy  the  foreground  of  con- 
sciousness, is  therefore  mainly  a  reflex  of  the  state  and  activity 
of  the  processes  that  take  place  in  the  abdominal  viscera. 

Those  crapulous  philosophers  who  maintain  that  happi- 
ness lies  in  the  integrity  of  the  digestive  powers,  are  there- 
fore not  without  justification.  The  enormous  influence  of 
the  abdominal  processes  upon  the  condition  of  the  conscious 
self  is  seen  in  many  instances  quite  outside  the  range  of 
ordinary  insanity.  If  a  man  receives  from  a  swinging  boom 
a  blow  on  the  leg  which  is  severe  enough  to  break  the  bone, 
he  suffers  from  the  shock  of  the  injury,  but  he  experiences 
no  special  and  peculiar  depression  out  of  proportion  to  the 
gravity  of  the  injury  that  he  has  received.  But  let  the  same 
man  receive  a  much  slighter  blow  in  the  abdomen,  and  the 
effect  upon  his  sense  of  well-being  is  terrific  ;  he  sinks  to 
the  ground,  not  merely  shocked,  but  collapsed  ;  his  eyes 
are  sunk,  his  nose  is  peaked,  a  cold  sweat  breaks  out  all  over 


324  SANITY    AND    INSANITY. 

him,  his  heart's  action  is  feeble  and  fluttering,  his  pulse 
almost  imperceptible,  he  gasps  for  breath,  and  his  con- 
sciousness is  one  of  awful  and  unutterable  misery.  A  minute 
ago  he  was  an  active,  vigorous  being,  buoyant  with  a  feeling 
of  health  and  well-being  ;  now  he  is  sunk  in  misery  so 
great  as  to  be  altogether  indescribable.  Death  is  longed  for 
as  a  welcome  relief  from  a  state  so  intolerable.  Let  a  man 
suffer  from  a  toothache  or  the  pain  of  an  abscess,  and  his 
uneasiness  is  great.  He  moans  and  suffers  ;  but,  great  as 
the  pain  is,  it  is  bearable,  and  through  it  all  he  looks  forward 
to  the  time  when  it  shall  cease,  and  he  shall  be  himself  again. 
Severe  it  may  be,  but  it  does  not  altogether  incapacitate 
him.  If  he  is  brought  a  paper  to  sign,  he  can  still  look  it 
through  and  decide  whether  or  no  he  shall  affix  his  signa- 
ture. But  let  the  same  man  suffer  from  colic,  and  what  a 
difference  there  is  in  his  consciousness  !  There  is  no  looking 
forward  now  ;  nothing  but  a  blank  despair,  an  annulment 
of  energy,  a  feeling  of  utter  misery.  It  is  no  use  bringing 
him  a  paper  to  sign,  or  asking  him  to  transact  business  ;  he 
is  too  much  occupied  with  his  own  wretchedness  to  have 
attention  for  anything  else  ;  his  energies  are  too  reduced  to 
allow  him  to  make  any  effort  necessary  for  a  business 
transaction. 

If  such  be  the  effect  of  sudden  and  acute  disorders  of  the 
abdominal  viscera,  we  may  be  sure  that  disorders  which  are 
less  acute  in  character  and  more  prolonged  in  duration,  will 
have  a  mental  accompaniment  that  is  similar  in  kind,  but 
that  presents  modifications  corresponding  with  those  of  the 
bodily  disorder.  And  that  is  what  we  do  find.  General 
physicians,  who  have  great  experience  in  the  observation  of 
abdominal  disorders,  are  emphatic  in  their  declarations  of 
the  lowering  of  the  mental  tone  and  the  prevalence  of  a 
melancholy  turn  of  mind  which  commonly  accompany 
abdominal  disorders.  There  is  a  peculiar  expression  of 
mingled  anxiety  and  misery  which  so  generally  accompanies 
abdominal  diseases  that  it  is  known  as  the  abdominal  fades. 
Most  persons  have  been  gratified  by  the  relief  that  has  been 


THE    FORMS   OF    IXSAXITY.  325 

gained  from  a  fit  of  unaccountable  depression  by  the 
operation  of  a  brisk  purge  ;  and  the  vendors  of  the  quack 
nostrums,  so  largely  advertised,  depend  on  this  physiological 
law  for  the  continuation  of  their  sales  and  the  success  of 
their  business. 

The  same  connection  between  the  sense  of  well-being  and 
the  working  of  the  abdominal  viscera  is  seen  in  many  other 
occurrences.  When  a  child  is  whining  and  fretting,  its 
mother  says  that  its  "  stomach  is  out  of  order,"  and  gives  it 
a  purge  ;  and  her  opinion  is  commonly  justified  by  the 
event.  The  horror  and  wretchedness  of  a  nightmare  are 
held  to  be  sufficiently  accounted  for  by  an  indigestible 
supper.  The  chronic  dyspepsia  from  which  Carlyle  suffered 
is  adduced  in  apology  for  his  morose  disposition.  Dysentery 
and  diarrhoea  are  the  scourge  of  armies,  but  much  more  of 
defeated  armies.  When  subscriptions  are  to  be  collected  for 
a  charity,  the  donors  are  first  warmed  into  a  generous  and 
expansive  mood  by  the  administration  of  a  good  dinner  ; 
and  the  effect  is  seen  in  the  fact  that  the  subscriptions 
following  a  charity  dinner  often  amount  to  thousands,  while 
those  elicited  by  the  most  persuasive  sermons,  which  are 
commonly  delivered  to  fasting  stomachs,  rarely  exceed  a 
very  few  hundreds. 

The  activity  of  the  abdominal  visceral  processes,  and 
therefore  the  effect  upon  the  state  of  nervous  tension, 
and  so  upon  the  sense  of  well-being,  depends  on  two  factors  : 
first,  the  structural  integrity,  and  second,  the  innervation. 
If  there  be  any  structural  malady,  as  a  catarrh  of  the 
mucus  membrane  of  the  stomach  or  intestine,  a  dilatation 
of  the  stomach,  an  ulcer  or  constriction  in  the  intestinal 
tract,  a  gallstone,  or  other  disorder  of  the  liver;  or  if 
there  be  disordered  working  from  the  irritation  of  in- 
digestible food,  or  emetics,  or  what-not  ;  then  there  is 
alteration  of  the  visceral  nerve  currents  going  to  the  brain, 
and  then  there  is  a  diminution  of  nerve  tension  generally, 
and  a  feehng  of  depression.  But  this  depression  does  not 
sensibly  surpass  the  limits  of  the  normal.     It  is  not  pro- 


326  SANITY    AND    INSANITY. 

found  ;  it  is  not  associated  with  delusion.  It  is  a  mere 
depression  of  more  or  less  transient  duration.  '  But  when 
there  is  torpor  of  the  abdominal  organs  owing  to  defective 
innervation — that  is,  to  deficiency  in  the  volume  and  intensity 
of  the  nerve  currents^  which  set  going  and  regulate  the 
processes — then  the  depression  is  of  more  serious  character. 
In  such  a  case  the  fact  that  the  innervation  is  defective 
indicates  a  derangement  of  the  central  nervous  system. 
That  part  of  the  higher  nerve  regions  Avhich  represents  the 
visceral  motor  processes  is  not  working  efficiently.  The 
tension  of  its  energy  is  below  normal,  and  the  currents 
which  it  emits  are  of  subnormal  tension.  Consequently 
the  abdominal  processes  are  inefficiently  and  sluggishly 
conducted,  and  the  reverse  currents — the  currents  returning 
to  the  superior  nerve  regions  —  are  greatly  reduced  in 
intensity  ;  hence  in  these  cases  there  is  a  vicious  circle  of  ill 
effects.  The  primary  defect,  inefficient  action  of  the  higher 
nerve  regions,  representing  the  body  generally,  produces  an 
inefficiency  in  the  innervation  of  the  whole  body  ;  hence  a 
lack  of  muscular  activity,  and  a  sluggishness  in  the  move- 
ments of  nutrition.  The  weight  of  this  inefficiency  falls 
with  specially  onerous  burden  on  the  abdominal  viscera,  and 
diminishes  their  activity.  This  diminution  of  activity  is,  of 
course,  represented  in  the  diminution  of  the  upward  currents 
which  they  transmit  to  the  brain  ;  and  the  higher  nerve 
regions,  lacking  their  normal  stimulus,  are  confirmed  in 
the  inefficiency  of  their  action.  The  mental  reflexion  of 
this  diminution  of  activity  in  those  highest  nerve  regions  in 
which  the  visceral  and  nutritive  processes  are  represented,  is 
diminution  of  the  feeling  of  well-being,  or  mental  depression. 
It  may  be  that  the  inefficient  working  is  confined  for  a  time 
to  these  particular  regions  of  the  highest  nervous  arrange- 
ments, and  that  for  a  time  the  condition  is  one  of  simple 
melancholy  without  delusion,  but  this  condition  can  be  only 
temporary.  Seeing  that  the  primary  and  initial  defect  was 
in  the  highest  nervous  arrangements,  which  represent  the 
whole  organism,  and  adjust  the  organism  to  its  surround- 


THE   FORMS   OF    INSANITY.  327 

ings,  it  can  hardly  be  that  the  representation  of  the 
organism  can  be  altered  and  disordered  without  its  adjust- 
ment to  surroundings  being  altered  and  disordered  likewise ; 
and  hence,  although  the  coensesthesis  suffers  first  and  most, 
and  the  consciousness  of  self  is  most  disturbed,  it  will  soon 
follow  that  the  relations  of  self  to  surroundings  will  suffer, 
for  the  self,  being  wrongly  represented,  must  also  be  wrongly 
adjusted. 

Then   not  only  may  either  of  the  chief  moieties  of  the 
nervous  system  be  affected  with  preponderant  gravity,  but, 
within  each  moiety,  similar  irregularities  of  distribution  of 
the  defect  may  obtain.     It  has  already  been  shown  how,  in 
sleep,  the  obliteration  of  function  may  proceed  irregularly, 
so    as   to    leave  islets    of   tissue    outstanding,    unsubmerged 
beneath  the  tide   of  inactivity  ;   and   how    the    activity   of 
these  unsubmerged  and  disconnected  islets  has  its   mental 
counterpart    in    the    phenomena  of  dreams.      It    has   been 
shown,  too,  how  the  activity  of   these  isolated  portions  is 
sometimes  of  sufficient  intensity  to  spread  downwards  and 
set  up  action  of  the  middle  and  lower  regions,  producing 
actual   movements,   the    defective    conduct   and    imperfect 
consciousness  of  somnambulism.     The  same  state  of  affairs 
may  exist  as  a  more  permanent  condition,  with  differences 
in  the  amount  and  distribution  of  the  areas  thus  left  out- 
standing, and  then  the  patient  exhibits  a  form  of  insanity 
accompanied  by  delusion.     Persons  who  are  thus  affected  are 
virtually  in  a  condition  of  permanent  somnambulism.     The 
state  of  their  brains  is  virtually  the  same  as  that  of  the  brain  of 
the  somnambulist,  and  the  delusions  of  the  one  resemble  the 
dreams  of  the  other,  not  merely  in  their  general  nature  but 
often   in  their  particular   form  also.      Thus,  many  people 
have    dreamt,  at    one    time    or    another,  of   witnessing,    as 
bystanders,  their    own    death,    or    of  attending   their    own 
funerals.     I  have  at   present   under  care   a  patient   w^ho  is 
tormented  by  the  continual  necessity  of  attending  his  own 
funeral  procession.     So,  too,  we  are   all  famihar   with  the 
colour  which  is  given  to  our  dreams  by  impressions  reaching 


328  SANITY   AND   INSANITY. 

US  from  without — how  the  exposure  of  the  legs  to  cold  by 
kicking  off  the  bedclothes  may  give  rise  to  a  dream  that 
we  are  wading  in  cold  water  ;  or  the  clanging  of  a  bell  may 
start  a  dream  of  an  alarm  of  fire,  and  so  forth.  In  precisely 
the  same  way,  the  delusions  of  the  insane  are  coloured  by 
the  events  that  are  passing  around  them.  The  sight  of 
three  or  four  people  talking  together  in  the  road  will  start 
the  delusion  that  they  are  conspiring  against  the  patient  ; 
the  wind  whistling  in  the  chimney  will  be  interpreted  as 
voices  calling  to  him  ;  the  floating  specks  in  the  humours  of 
his  eye  will  appear  to  him  as  rats  or  mice,  or  birds  flying 
about  him. 

Such  are  the  results  of  irregularities  in  the  distribution  of 
a  defect  that  is  confined  to  the  higher  nerve  regions  ;  but 
defects  are  not  always  so  confined.  It  may  be  that  there  are 
defects  throughout  the  whole  hierarchy  of  nerve  regions, 
but  that  throughout  they  are  irregularly  distributed,  and 
that  not  only  are  the  several  regions  disproportionately 
affected,  but  the  several  parts  of  each  region  are  also  affected 
disproportionately.  Thus,  for  instance,  we  have  seen  that 
in  drunkenness  the  middle  and  lower  centres  are  often 
affected  disproportionately  to  the  higher,  so  that,  while  the 
head  is  comparatively  clear,  the  power  of  walking,  or  the 
movements  of  the  hands  or  the  ability  to  articulate  clearly, 
are  much  affected.  Similarly  we  find  that  in  general 
paralysis,  which  is  the  permanent  counterpart  of  drunken- 
ness, it  occasionally  happens  that  the  movements  are  greatly 
affected  while  the  mind  remains  fairly  clear,  while  in  others 
the  mind  is  much  impaired  with  little  defect  in  the  bodily 
movements. 

Secondly,  the  form  of  the  insanity  depends  largely  upon  the 
rapidity  with  which  the  failure  occurs.  The  rule  is  that  the 
more  rapidly  the  higher  apparatus  is  put  out  of  gear,  the 
more  prominent,  the  more  excessive,  is  the  overaction  of 
the  apparatus  immediately  below  the  part  so  abolished.  In 
other  words,  the  more  suddenly  control  is  removed,  the 
more  rampant  is  the  overaction  of  the  parts  which  have 


THE    FORMS    OF    INSANITY.  32q 

been  freed  from  control.  In  this  particular  the  nervous 
system  conforms  to  a  law  which  is  not  peculiar  to  itself,  but 
prevails  universally  throughout  activities,  both  animate  and 
inanimate.  The  efficiency  of  a  spring  in  projecting  a  pro- 
jectile depends  largely  on  the  suddenness  with  which  it  is 
released.  There  is  an  explosive  substance  used  in  mines 
which  cannot  be  exploded  unless  the  cohesive  force  which 
binds  its  molecules  together  is  suddenly  removed.  Set  fire 
to  it  and  it  burns  quietly  away,  but  hammer  a  percussion 
cap  upon  it  and  it  bursts  out  with  explosive  violence.  So, 
when  a  lad,  who  has  been  kept  at  home  under  very  rigid 
discipline,  is  suddenly  turned  out  into  the  world  and  made 
his  own  master,  he  is  far  more  apt  to  plunge  into  dissipa- 
tion and  excess  than  one  who  has  been  prepared  for  his 
freedom  by  a  gradual  relaxation  of  parental  authority.  So 
when  a  nation  which  has  been  ground  down  under  a  burden 
of  tyranny  is  suddenly  released,  it  indulges  in  wild  excesses 
of  license,  as  did  the  French  at  the  first  Revolution  ;  while 
one  which  has  obtained  its  freedom  by  the  gradual  relaxation 
of  its  bonds,  retains  at  each  increment  of  liberty  its  self- 
control.  So  it  is  with  the  nervous  system  ;  the  more  rapid 
the  removal  of  the  control  of  the  higher  regions,  the  more 
excessive  is  the  overaction  of  the  lower. 

It  will  be  remembered  that  the  fundamental  property  of 
nervous  matter  is  its  susceptibility  to  change.  It  is  change 
alone  that  will  set  going  a  nervous  discharge.  When  a 
continuous  current  of  electricity  is  applied  to  a  nerve,  no 
discharge  is  produced  ;  but  let  the  current  be  altered  in 
any  way  and  at  once  a  contraction  is  produced  in  the 
muscle  to  which  the  nerve  is  distributed.  When  the  current 
is  increased  there  is  a  contraction  ;  Avhen  the  current  is 
diminished  there  is  a  contraction  ;  when  the  current  is 
first  applied,  and  when  it  is  arrested,  contractions  take  place. 
The  cause  of  the  discharge  through  the  nerve  is  a  change  in 
the  conditions  under  which  the  nerve  is  placed.  Now  we 
have  already  seen  that  in  the  gravity  of  a  change  there  are 
two  elements,  magnitude  and  suddenness.     The  greater  the 


330  SANITY   AND   INSANITY. 

difference  between  the  state  to  which,  and  the  state  from 
which,  the  change  is  made,  the  more  decided  is  the  change  ; 
and  the  more  rapid  is  the  passage  from  the  one  state  to  the 
other,  the  more  decided  is  the  change.  In  every  change 
these  two  elements  of  magnitude  and  suddenness  are  the 
prime  factors  in  determining  the  effect  that  the  change 
produces.  What  is  true  of  the  component  parts  of  the 
nervous  system  is  true  of  the  whole  which  they  compose. 
If  the  electric  current  that  is  applied  to  a  nerve  be  very 
slowly  and  cautiously  diminished,  and  at  last  be  gradually 
turned  off  altogether,  it  may  be,  if  the  operation  is  conducted 
with  sufficient  care,  that  no  current  of  discharge  may  be 
produced  in  the  nerve,  and  no  contraction  may  take  place  in 
the  muscle  to  which  it  is  distributed.  But  if  the  most 
perfect  graduation  be  not  maintained,  if  a  jerk  or  a  jolt  or 
even  a  variation  in  rapidity  occurs  in  the  process,  then  a 
discharge  is  set  up  and  a  contraction  is  produced.  In  the 
same  way  the  deletion  and  obliteration  of  the  highest  nerve 
regions,  if  it  go  on  very  slowly,  may  be  accomplished  without 
any  effect  of  letting  loose  being  produced  on  the  centres 
below.  But  if  the  process  be  rapid,  if  it  be  irregular,  and 
more  especially  if  it  be  sudden,  then  an  outbreak  of  discharge 
"svill  inevitably  occur  from  the  centres  below,  and  this  out- 
break will  be  grave  in  proportion  to  the  suddenness  with 
which  the  control  has  been  removed. 

Although  the  most  frequent  condition  of  overaction  is  the 
letting  go  of  an  inferior  centre  by  the  sudden  removal  of  the 
control  exercised  by  its  superior,  yet  this  is  not  the  sole 
occasion  of  excessive  action  of  nerve  tissue.  The  nervous 
tissue  of  no  two  people  is  quite  alike  in  the  readiness  with 
which  it  parts  with  its  accumulated  energy.  Some  are 
naturally,  even  from  boyhood,  lively,  mercurial,  and  effer- 
vescent ;  others  are  staid,  solemn,  and  lethargic.  In  some 
people,  owing  to  some  fault,  some  defect  in  the  stability  and 
cohesion  of  the  nerve  molecules,  discharge  of  energy  breaks 
out  from  time  to  time  in  great  excess  and  with  great 
suddenness,  and  occasions  the  phenomena  of  epilepsy.      In 


THK    FORMS   OF    INSANITY.  331 

Other  people,  in  whom  the  nerve  molecules  are  not 
abnormally  unstable,  the  direct  application  to  them  of  some 
liberating  agent  may  unlock  their  stores  of  energy  and 
produce  an  unusual  outpouring.  Such  is  the  case  when 
from  any  cause  a  great  flush  of  blood  occurs  to  the  brain  or 
to  any  part  of  it  ;  and  hence  we  find  that  the  part  of  the 
brain  in  the  neighbourhood  of  actively  growing  tumours  is 
especially  liable  to  epileptic  discharges  ;  hence,  too,  we  find 
that  in  that  more  chronic  inflammation  of  the  brain  which 
is  the  basis  of  general  paralysis  of  the  insane,  epileptic  fits 
are  common.  Such  directly-actuated  discharges  are  not 
always,  however,  so  sudden  and  so  excessive  as  to  produce  the 
terrible  phenomena  of  epilepsy.  When  they  are  of  more  con- 
tinuous duration,  and,  while  excessive,  yet  less  tremendously 
excessive,  they  give  rise,  not  to  epileptic  seizures,  but  to  a 
generally  heightened  state  of  the  tension  of  energy  through- 
out the  whole  or  throughout  large  areas  of  the  nervous 
system.  Such  a  condition  of  heightened  tension  of  nerve 
energy  obtains  throughout  the  course  of  general  paralysis, 
and  is  only  raised  to  the  intensity  necessary  for  an  epileptic 
discharge  upon  occasion  and  at  intervals.  Such  a  condition 
of  heightened  tension  follows  also  upon  the  rush  of  blood 
supply  that  takes  place  in  drunkenness. 

Lastly,  the  form  of  the  insanity  varies  with  the  nature  of 
the  person  who  becomes  insane.  It  is  obvious  that  if  insanity 
is  the  removal  of  the  higher  nature  of  the  individual,  the 
manifestation  of  the  insanity  must  depend  upon  the  character 
of  what  is  left  when  this  veneer  of  higher  or  more  lately 
developed  qualities  is  removed.  It  is  an  old  observation 
that  ill  vino  Veritas  : — that  when  a  man  is  drunk  his  true  or 
underlying  nature  and  disposition  show  themselves  unclouded 
and  unhidden  by  the  accumulation  of  superficial  qualities 
that  he  has  superadded  in  the  course  of  his  life.  Hence  we 
find  often  a  surprising  alteration  in  the  disposition  of  a  man 
when  he  is  in  his  cups.  The  miser  becomes  generous,  the 
amiable  man  quarrelsome,  the  advocate  of  purity  becomes 
lecherous,  the  retiring  and  modest  man  boastful  and  arrogant. 


332  SANITY   AND    INSANITY, 

So  when  a  man  becomes  insane  there  is  often  an  entire 
change  in  his  disposition  and  character — a  change  which  is  to 
be  accounted  for,  not  by  the  addition  of  any  new  ingredient 
to  his  nature,  but  by  the  uncovering  and  exposure  of 
underlying  quaHties  which  were  always  present  in  him,  but 
which  were  overlaid,  obscured,  and  suppressed  by  qualities 
of  later  acquisition. 

When  we  consider  how  infinite  may  be  the  variations  in 
the  extent  and  distribution  of  the  areas  of  the  nerve  regions 
whose  function  may  be  removed  ;  how  many  grades  and 
degrees  in  the  rapidity  of  the  loss ;  how  great  the  differences 
in  the  degree  to  which  the  nervous  tension  may  be  raised 
or  lowered  ;  and  how  various  the  dispositions  left  exposed 
by  their  removal  ;  we  can  well  understand  how  indefinitely 
various  are  the  manifestations  of  insanity  ;  and  a  considera- 
tion of  the  number  and  varieties  of  ways  in  which  these 
factors  may  be  combined,  will  give  us  an  idea  of  the  way  in 
which  the  several  forms  of  insanity  merge  into  one  another, 
of  the  indistinctness  of  their  boundaries,  and  of  the  way  in 
which  the  same  patient  may  exhibit  a  combination  of  two  or 
more  forms.  At  the  same  time,  the  nature  of  the  factor 
which  gives  to  the  case  its  most  prominent  characteristic 
provides  us  with  a  principle  of  classification  by  which  we 
may  group  together  the  cases  which  have  most  in  common 
and  separate  them  from  those  that  they  resemble  least. 

So  classified,  we  shall  find  that  the  forms  of  insanity 
group  themselves  as  exhibited  in  Table  I.  It  is  evident 
that  a  little  shuffling  of  the  cards  will  produce  the  modified 
classification  of  Table  II.  ;  and  which  of  these  methods  is 
chosen  is  not  of  great  importance.  The  main  principle  to 
recognize  is,  that  the  form  of  insanity  varies  with  the  region 
and  the  extent  of  the  nervous  system  most  affected,  and 
varies  also  according  as  the  affection  is  a  loss  of  function,  or  an 
increase  or  decrease  in  the  tension  of  the  circulating  energy. 

Since  the  several  portions  of  the  nervous  system  are  not 
isolated  from  one  another,  but  are  interwoven  in  intricate 
combinat'ions,  it  will  be  rare  for  disorder  to  affect  gravely 


THE    FORMS   OF    INSANITY. 


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THE   FORMS   OF   INSANITY.  335 

one  portion  while  all  others  are  unaffected,  and  it  will  be 
common  for  several  or  many  portions  to  be  affected  at  once. 
Hence  that  loss  of  action  in  certain  areas  of  the  inner 
circulation  of  nerve  energy,  which  is  the  foundation  of 
delusions  of  self,  will  often  be  combined  with  similar  losses 
in  areas  of  the  outer  circulation,  which  have  for  their  accom- 
paniment delusions  of  the  relation  of  self  to  surroundings. 

As  loss  of  function  in  areas  of  the  highest  nerve  regions 
indicates  that  some  deteriorative  process  has  attacked  these 
regions,  it  w^ill  often  happen  that  this  process  either  begins, 
or  at  some  time  in  its  progress  assumes,  a  rapidly  destructive 
character.  When  the  destruction  proceeds  rapidly,  over- 
action  takes  place  in  the  regions  beneath  those  destroyed, 
and  hence  it  happens  that  mania  is  a  frequent  accompani- 
ment of  the  delusional  form  of  insanity. 

While  the  manifestations  of  insanity,  in  so  far  as  they  are 
manifestations  of  insanity  only,  depend  on  disorder  of  the 
highest  nerve  regions,  it  will  frequently  happen  that  the 
deteriorating  process  to  which  disorder  of  these  regions  is 
due,  by  no  means  confines  its  action  to  these  regions,  but 
affects  the  whole  of  the  nervous  system  throughout  all  its 
extent.  The  external  signs  of  disorder  of  the  middle  and 
lower  regions  are  of  course  not  those  of  insanity,  but  are 
disorders  of  movement,  defects  of  sensibility,  and  faults  of 
muscular  action.  When  the  deteriorating  process  extends 
throughout  the  nervous  system,  such  disorders  of  movement, 
&c.,  on  lower  levels,  accompany  the  insanity,  though  they 
do  not  constitute  part  of  it  ;  and  the  case  presents  an 
ensemble  of  insanity  and  bodily  disorder  which  has  to  be 
considered  clinically  as  a  whole,  although  from  a  psycho- 
logical point  of  view  the  bodily  disorder  is  a  mere  excrescence 
on  the  insanity,  which  has  to  be  considered  separately. 
Such  a  combination  of  bodily  defect  with  insanity  occurs  in 
dementia,  and  conspicuously  in  general  paralysis  of  the 
insane. 


CHAPTER  XIII. 

THE  FORMS  OF  INSANITY  (Continued), 

Melancholia. 

The  first  form  of  insanity  that  presents  itself  for  considera- 
tion is  that  in  which  the  weight  of  the  defect  lies  with 
especial  severity  upon  the  visceral  nervous  system,  and 
affects  secondarily,  and  with  less  urgency,  that  moiety  of 
the  system  which  operates  the  adjustment  of  self  to  sur- 
roundings. 

The  working  of  the  visceral  and  nutritive  portion  of  the 
nervous  system  may  be  disordered  in  one  of  three  ways  : — 

1.  There  may  be  simple  defect  of  activity. 

2.  There  may  be  simple  excess  of  activity. 

3.  There  may  be  defect  of  activity  more  or  less  extensive, 
with  isolated  areas  left  outstanding  in  which  activity  is 
normal  or  in  excess. 

Each  of  these  errors  in  working  may  be  associated  with 
errors  in  the  working  of  the  major  circulation  of  nerve 
energy. 

When  there  is  simple  defect  of  activity,  and  a  low  state  of 
tension  of  energy  in  the  visceral  and  nutritive  moiety  of 
the  nervous  system,  two  concomitant  and  parallel  sets  of 
phenomena  are  observed.  In  the  first  place,  the  processes 
which  are  served,  maintained,  and  regulated  by  this  portion 
of  the  nervous  system,  are  lacking  in  vigour,  activity,  and 
intensity  ;  and  in  the  second  place  the  consciousness  of  self, 
which  is  the  mental  accompaniment  of  the  activity  of  this 
part  of  the  nervous  system,  is  lacking  in  buoyancy,  and  in 
the  feeling  of  well-being. 


THE    FORMS    OF    INSANITY.  337 

We  find,  therefore,  that  in  melancholia  there  is  evidence  of 
want  of  vigour  in  all  the  bodily  processes.  The  hair  grows 
but  slowly,  the  nails  seldom  want  cutting,  the  mouth  is 
dry,  the  digestion  is  sluggish,  the  bowels  are  constipated, 
the  pulse  is  feeble,  the  breathing  is  shallow,  the  muscles  are 
flabby,  the  bodily  activity  is  diminished.  Together  with 
these  bodily  manifestations  goes  a  depression  of  spirits 
which  varies  in  degree  from  a  trifling  want  of  buoyancy  to 
the  profoundest  misery  and  despair. 

We  have  seen  that  in  the  normal  organism  there  are 
diurnal  fluctuations  of  the  nervous  tension,  with  cor- 
responding fluctuations  in  the  activity  of  the  bodily  pro- 
cesses and  in  the  buoyancy  of  the  temperament.  We 
have  seen  how  in  the  forenoon,  when  the  nervous 
tension  is  highest,  the  bodily  activity  is  greatest,  the 
intellect  is  keenest,  the  highest  order  of  feelings  become 
predominant  ;  at  the  same  time  the  viscera  are  most  actively 
performing  their  functions,  digestion,  secretion,  excretion, 
intestinal  movements  are  most  vigorous  ;  and  correspondingly 
the  sense  of  well-being  is  at  its  maximum.  There  is  in  the 
morning  a  buoyancy  of  mind,  a  flow  of  high  spirits,  a 
general  hopefulness  and  enthusiasm  which  is  unknown  at 
other  times.  As  the  day  wanes,  all  these  signs  of  activity 
diminish  ;  conduct  becomes  more  languid,  consciousness 
is  less  intensely  vivid,  the  processes  of  nutrition  and  the 
visceral  functions  are  less  active  ;  and  correspondingly  the 
flow  of  high  spirits,  the  eagerness,  the  gaiety  of  mind 
subside.  As  the  time  goes  on,  and  the  small  hours  of  the 
morning  are  reached,  the  tide  of  energy  reaches  its  lowest 
ebb  ;  exertion  becomes  difficult,  almost  painful,  the 
intellect  is  dull  and  sluggish,  the  visceral  and  nutritive 
processes  are  inactive,  the  tide  of  nerve  tension  is  at  its  ebb, 
and  the  general  feeling  of  well-being  is  supplanted  by  a 
feeling  of  misery.  Such  a  feeling  at  such  a  time  is  in  no 
respect  abnormal,  unless  it  is  very  excessive  in  degree  ;  but 
if  this  low  tide  of  nervous  energy,  with  its  accompanying 
inactivity  of  conduct,  its  torpor   of  visceral  and  nutritive 

23 


338  SANITY    AND    INSANITY. 

processes  and  its  feeling  of  misery,  persist  the  whole  twenty- 
four  hours  round,  and  continue  day  after  day,  then  the 
state  of  things  is  no  longer  normal  ;  then  the  modification 
of  mind,  of  conduct,  and  of  nutrition  amount  to  positive 
disorder,  and  the  case  becomes  one  of  insanity — of  that  form 
of  insanity  which  is  known  as  melancholia. 

The  symptoms  or  manifestations  of  melancholia  are  nothing 
more  than  a  persistence,  in  more  or  less  exaggerated  form,  of 
those  which  every  one  experiences  in  some  degree  who  is 
wakeful  between  three  and  four  o'clock  in  the  morning. 
The  most  marked  and  conspicuous  feature  of  the  malady — 
the  leading  symptom — is  the  depression  of  spirits  which 
always  characterizes  it.  This  feature  in  never  absent.  In 
some  cases  it  is  extreme  in  its  severity,  in  others  it  is  com- 
paratively little  ;  but  whether  severe  or  trifling,  it  betrays  its 
origin,  and  indicates  its  relation  with  the  normal,  by  invari- 
ably being  worst  in  the  early  morning.  In  slight  cases  the 
melancholy  is  perhaps  present  only  in  the  early  mornings, 
midday  being  a  time  of  almost  normal  cheerfulness.  In 
cases  in  which  the  depression  is  so  great  as  to  lead  to 
attempts  at  suicide,  the  tendency  to  make  these  attempts  is 
greatest  in  the  early  morning  ;  and  it  is  well  known  to  those 
who  have  the  conduct  of  asylums  that  it  is  in  the  early 
morning  hours  that  the  most  vigilant  watchfulness  is 
required.  In  slight  cases,  the  melancholy  amounts  only  to  a 
feeling  of  dissatisfaction,  of  diffidence  in  their  own  powers, 
and  general  vague  unhappiness  ;  but  in  severe  cases  this  is 
the  most  dreadful  malady  that  can  afflict  a  human  being. 
In  such  cases  the  patient  has  a  most  miserable  expression  of 
face,  his  head  droops  on  his  breast,  his  arms  hang  listless 
by  his  sides,  his  forehead  is  puckered  into  innumerable 
wrinkles,  his  eyes  are  sunk,  he  weeps  either  constantly  or 
frequently,  his  mouth  is  a  picture  of  woe,  and  his  whole 
attitude  and  expression  are  suggestive  of  misery  and  despair. 
Question  him,  and  he  does  not  answer ;  urge  your  question, 
and  he  groans  and  wrings  his  hands  ;  still  urge  him,  and  he 
cries,  and  says  in   a  feeble   monotone   that  he   is  the  most 


THE    FORMS   OF    INSANITY. 


339 


miserable  and  most  wicked  of  men — that  he  is  accursed  of 
God  and  man — that  he  has  committed  the  unpardonable  sin, 
the  sin  against  the  Holy  Ghost — that  his  wickedness  is  un- 
speakable— that  he  is  unfit  to  live. 

In  some  cases  the  overwhelming  feeling  of  misery  is  mani- 
fested in  the  most  striking  ways  :  the  patient  sits  all  day, 


Fig.  i8. 


rocking  himself  backward  and  forward,  moaning  and  wailing 
in  intolerable  distress.  In  one  case  recorded  by  Dr.  Savage 
the  patient  never  opened  his  lips  except  to  repeat  the  single 
phrase,  "  Dead  and  dammed."  He  "  spoke  only  that  one 
phrase,  as  if  in  that  one  phrase  his  soul  he  did  outpour." 

When  the  lack  of  nervous  tension  is  not  very  great,  and  the 
feeling  of  misery  not  very  profound,  there  may  be  little  or  no 


340 


SANITY   AND   INSANITY. 


evidence  of  disorder  of  the  other  great  moiety  of  the  nervous 
system — that   which  adjusts  self  to  surroundings.     In  such 


[' 


cases  there  is  simple  depression — a  feehng  of  unhappiness, 
which  IS  not  justified  by  the  circumstances  of  the  individual, 


THE    KOKMS    OK    INSANITY.  34^ 

and  for  which  he  is  unable  to  account.  But  when  the  disorder 
of  feehng  is  profound,  it  is  always  accompanied  by  more  or 
less  disorder  of  intellect— by  more  or  less  marked  delusion. 
The  delusions  of  melancholia  arise  in  two  ways,  or  rather 
have  a  twofold  cause,  each  moiety  of  which  corroborates  and 
enforces  the  other.  In  the  first  place,  the  profound  feehng  of 
misery  naturally  sets  its  unfortunate  possessor  casting  about 
to  discover  a  cause  for  it.  Normally  a  feeling  of  misery  is  the 
state  which  corresponds  with  some  untoward  relation  of  our 
surroundings  towards  us.  Consequently,  when  a  feeling  of 
misery  is  experienced,  there  is  a  natural  tendency  to  seek  for 
circumstances  which  would  justify  and  explain  it.  If  no 
such  circumstance  is  immediately  apparent,  the  tendency 
will  be  to  think  "It  must  be  so  and  so" — a  judgment  of 
God  for  a  sin  committed,  or  an  impending  financial  disaster, 
or  what  not.  From  the  idea  that  it  must  be  so  to  the  idea 
that  it  is  so  is  not  a  long  step,  and  is  a  step  which  we  are 
occasionally  actual  witnesses  of,  the  lapse  of  a  few  days  or 
a  week  being  sometimes  enough  to  transform  the  one  declara- 
tion into  the  other. 

The  other  cause  of  the  delusions  of  melancholia  is  in  the 
actual  disordered  working  of  the  mental  processes,  concomitant 
with  the  disorder  of  the  working  of  the  highest  nerve  pro- 
cesses, which  is  inevitable  from  the  low  tension  of  the  nervous 
energy  which  obtains  there.  If  we  remember  that  these 
highest  nerve  regions  are  a  most  intricately  constituted 
plexus  of  intercommunicating  channels — some  of  which  are 
wide  and  freely  permeable,  while  others  are  small,  but  half 
excavated,  and  permeable  only  with  difficulty — it  will  appear 
evident  that  they  can  only  be  filled  and  thoroughly  per- 
meated by  the  currents  of  energy  when  the  tension  of  that 
energy  is  considerable.  When  the  tension  is  reduced,  the 
less  permeable  channels,  the  channels  in  which  the  energy 
passes  with  difficulty,  under  friction,  and  under  pressure,  will 
fail  to  be  traversed.  Those  only  will  have  the  passage 
through  them  effected,  which  are  widely  and  freely  perme- 
able.    Hence  will  result  an  irregular,  inefiicient  working  of 


342  SANITY    AND    INSANITY. 

the  higher  nerve  regions  ;  and  the  concomitant  of  irregular 
and  inefficient  working  of  these  regions  is  irregular  and 
inefficient  mental  action.  It  is  not  only  true  of  isolated 
channels  here  and  there  that  they  are  with  difficulty  per- 
meable to  strong  currents,  and  not  permeable  at  all  to  feeble 
currents  j  but  it  is  true  also  of  whole  areas  in  the  higher 
nerve  regions  that  they  are  thus  constituted,  if  and  when  they 
are  of  recent  formation.  Hence,  when  the  nerve  tension  is  low, 
these  areas  will  not  be  supplied,  their  withdrawal  from  the 
general  activity  will  disturb  the  balance  of  that  activity,  and 
will  thus  be  directly  productive  of  delusion. 

Whether  the  rationale  of  the  delusions  of  melancholia  is 
or  is  not  as  stated,  certain  it  is  that  the  ill-feeling  of  melan- 
cholia, when  at  all  pronounced,  is  always  accompanied  by 
delusion  ;  and  usually  the  delusions  bear  such  a  proportion 
to  the  feeling  of  unhappiness,  that  if  they  were  founded  in 
fact,  instead  of  being  delusions,  they  would  justify  an  amount 
of  unhappiness  pretty  near  to  that  which  is  actually  felt. 
Thus  we  do  not  usually  find  that  a  very  profound  degree  of 
misery  is  accompanied  by  a  delusion  of  some  trifling  injury, 
nor  that  a  light  degree  of  melancholia  accompanies  a  delusion 
about  eternal  damnation.  If  a  patient  has  but  a  slight 
degree  of  melancholy,  he  has  a  delusion  that  he  suffers  from 
some  comparatively  slight  misfortune — as,  for  instance,  that 
he  is  afflicted  Avith  the  itch,  or  that  he  has  a  weasel  inside  him. 
If  his  depression  be  of  a  more  severe  character,  his  delusion 
is  that  he  is  suffering  from  a  greater  misfortune,  as  that  he 
has  lost  his  fortune  and  is  coming  to  the  workhouse.  While 
if  he  is  buried  in  profound  gloom,  his  delusion  is  that  he  is 
the  unpardonable  sinner,  that  he  has  forfeited  the  mercy  of 
God,  and  will  suffer  eternally  in  hell. 

We  have  seen  that  the  depression  of  spirits  has  for  its 
physical  basis  a  low  ebb  of  tension  of  the  nervous  energy, 
and  that  this  same  physical  condition  has  its  physical  effect. 
If  the  energy  is  emitted  from  the  molecules  of  the  nervous 
system  in  greatly  diminished  intensity,  its  effecL  upon  the 
muscles  and  other  structures  to  which  it  is  distributed  will 


THE    FORMS   OF    INSANITY.  343 

be  greatly  diminished.  Now,  the  effect  of  the  nervous 
energy  upon  the  muscles  is  to  produce  movement,  and  its 
effect  upon  the  other  structures  to  which  it  is  distributed  is 
to  promote  activity  of  function.  Hence  we  find  that  in 
melancholia,  with  a  diminution  of  tension  of  nerve  energy 
there  goes  a  diminution  of  bodily  movement,  and  a  slackened 
activity  of  function  throughout  the  body. 

The  melancholic  person  invariably  exhibits  an  undue  lack 
of  bodily  activity.  That  is  a  rule  without  any  exception. 
There  is  no  authentic  case  on  record  of  a  lively,  active 
person  being  melancholy,  or  of  a  melancholy  person  exhibit- 
ing abounding  activity  ;  the  stories  of  Grimaldi  and  of 
other  acrobats  are  ben  trovato^  but  they  are  not  sufficiently 
authenticated  for  belief,  in  the  face  of  the  universal  experi- 
ence of  an  opposite  character  of  all  alienist  physicians. 
Doubtless  there  are  men  of  abounding  activity  whose  mental 
complexion  is  shaded  with  sadness  and  unhappiness,  but  that 
IS  because  there  are  circumstances  in  their  lives,  in  their 
relations  with  their  famihes,  their  social  surroundings,  or 
their  environment  generally,  which  produce  and  justify  such 
feelings.  The  sadness  of  a  man  who  has  lost  half  a  dozen 
promising  children  from  diphtheria,  or  who  is  ostracised 
from  society  because  of  the  drunken  and  violent  habits  of  his 
wife,  is  a  normal  sadness.  The  melancholy  which,  it  is  asserted, 
is  never  accompanied  by  a  high  degree  of  bodily  activity,  is 
a  spontaneous  and  autogenic  melancholy,  having  no  expla- 
nation or  justification  in  the  circumstances  in  which  the 
melancholy  man  is  placed. 

As  a  rule,  the  defect  in  the  bodily  activity  corresponds 
pretty  nearly  with  the  depth  of  the  melancholy.  Those  who 
are  but  a  little  sad,  are  languid,  slow  in  their  movements, 
disinclined  for  exertion  and  easily  fatigued.  But  they  do  of 
their  own  accord  undertake  their  duties,  and  strive  to  fulfil 
them  as  well  as  their  enfeebled  energies  will  allow.  Those 
whose  melancholy  is  more  profound,  relinquish  altogether 
their  daily  duties.  They  can  manage  to  get  about,  but  they 
stroll  languidly  and  indifferently.     What  they  do,  they  do 


344  SANITY    AND    INSANITY. 

slowly  and  feebly  ;  but  still  they  fulfil  the  commoner  and 
more  fundamental  duties  of  their  lives.  In  melancholia  of 
the  deepest  kind  the  torpor  is  profound.  The  patient  does 
not  dress  nor  undress  himself,  does  not  even  feed  himself, 
becomes  a  useless  log,  and  has  to  be  cared  for  like  a  child. 

With  this  depression  of  spirits,  with  this  disorder  of 
intelligence,  with  this  deficiency  of  conduct,  there  goes  in- 
variably a  torpor,  not  of  the  muscular  movements  only,  but 
of  all  the  bodily  processes.  The  defective  intensity  of  the 
currents  of  nerve-energy  shows  itself  not  only  in  deficiency 
of  the  muscular  movements,  but  in  deficiency  of  all  the  pro- 
cesses that  are  maintained  in  activity.by  nervous  influence. 
Hence  we  find  that  secretions  are  diminished,  the  skin  is 
dry,  the  hair  is  harsh  from  deficiency  of  the  glandular 
secretion  which  in  health  keeps  it  moist  and  supple,  the 
secretions  of  the  mouth  and  of  the  whole  gastro-intestinal 
tract  are  deficient.  In  addition,  the  muscular  movements 
of  stomach  and  intestines  are  of  course  defective.  For  both 
these  reasons  digestion  is  imperfect.  The  deficiency  of 
saliva,  of  gastric  and  intestinal  juices,  cause  the  chemical 
changes  of  digestion  to  be  imperfectly  performed.  The 
proper  solvents  of  the  food  not  being  applied  to  it  in  due 
quantity,  the  solution  of  the  nutritious  parts  of  the  food 
is  of  course  retarded  and  diminished.  The  movements  of 
stomach  and  intestine  being  deficient,  their  contents  are 
not  sufficiently  stirred  about,  the  deficient  solvent  does  not 
get  the  usual  chances  of  acting  equally  on  all  parts.  For 
these  reasons  the  digestion  of  melancholies  is  always  dis- 
turbed, and  an  invariable  accompaniment  of  the  disorder 
is  constipation. 

Since  digestion  is  so  imperfect,  we  should  expect  the  lack 
of  nourishment  borne  by  the  tissues  to  express  itself  in  a 
feeling  of  hunger,  but  this  is  not  the  case.  Melancholy 
persons  are  never  hungry  ;  and  the  reason  is  obvious. 
Hunger  is  the  feeling  which  accompanies  that  state  of  the 
body  in  which  nourishment  is  required  ;  that  is  to  say,  in 
which  the  stores  of  nutrient  material  present  in  the  body 


THE    FORMS    OF    INSANITY.  345 

have  been  used  up  in  the  repair  of  waste  and  the  main- 
tenance of  the  integrity  of  the  tissues.  But  in  melanchoHcs 
this  process  of  nutrition,  of  the  repair  of  waste,  of  the  main- 
tenance of  the  integrity  of  the  tissues,  is  itself  greatly  in- 
terfered with.  Regulated  as  it  is  by  the  nerve  currents, 
the  slackening  and  diminution  of  these  currents  involves 
the  slackening  and  diminution  of  the  process  of  nutrition 
throughout  the  body.  Hence  the  materials  are  used  up 
but  slowly,  the  want  of  new  pabulum  is  not  felt,  and  hunger 
is  not  experienced.  The  loss  of  appetite  is  one  of  the  most 
striking  and  conspicuous  features  of  melancholia,  and  it  is 
as  invariable  as  is  the  melancholy  feeling  itself.  No  case 
of  melancholia  has  ever  been  placed  on  record  in  which 
constipation  and  loss  of  appetite  were  not  present. 

Since  appetite  is  impaired,  but  little  food  is  taken  ;  and 
since  digestion  is  impaired,  the  full  amount  of  nourishment 
is  not  extracted  from  this  diminished  quantity  of  food ;  and 
hence  it  happens,  not  only  that  the  tissues  throughout  the 
body  are  inactive  in  repairing  the  normal  waste  of  their 
substance,  but  that  the  material  at  their  disposal  to  effect 
these  repairs  is  lessened  in  abundance  and  deteriorated  in 
quality.  Hence  the  repairs  are  but  imperfectly  and  inef- 
ficiently executed,  and,  as  the  waste  of  the  tissues  is  not  fully 
supplied,  they  diminish  in  bulk,  they  dwindle,  and  the  body 
v/astes.  Loss  of  weight  is  an  invariable  accompaniment 
of  melancholia. 

There  is  one  other  occurrence  which  it  is  necessary  to 
notice  in  order  to  complete  the  picture  of  melancholia.  We 
have  stated  that  this  disorder  is  an  exaggeration,  and  a  morbid 
counterpart,  of  the  depression  of  spirits  and  the  diminution 
of  bodily  function  that  normally  take  place  when  the  early 
morning  hours  are  sleepless.  This  extreme  diminution  of 
the  tension  of  the  nerve  energy  does  not  usually  occur 
during  sleep.  In  sleep  there  is  always,  of  course,  some 
running  down  of  the  tension,  some  considerable  diminution 
of  activity  of  the  nervous  molecules  ;  but  when  sleep  is 
obtained,  the  upper  layers  of  the  nervous  system  are  placed 


34^  SANITY   AND   INSANITY. 

altogether  out  of  action,  and  the^middle  layers  act  but  feebly 
and  upon  occasion.  Hence  whatever  energy  is  at  the  dis- 
posal of  the  organism  is  concentrated  in  the  lowest  regions 
of  the  nervous  system,  which  govern  and  actuate  the  visceral 
movements  and  the  processes  of  nutrition,  and  hence  for 
this  reason  these  movements  and  processes  are,  as  a  rule, 
rather  more  than  less  active  during  sleep,  and  their  mental 
reflection,  the  coensesthesis,  or  sense  of  the  condition  of  the 
body,  is  not  reduced.  So  far  as  we  are  conscious  during 
sleep  we  are  not  usually  unhappily  conscious,  but  rather 
the  reverse.  But  if  after  the  exertions  and  fatigues  of 
the  day  we  do  not  obtain  sleep  ;  if  during  those  hours 
in  which  the  highest  centres  are  calling  for  repose,  repose 
is  denied  to  them  ;  there  is  still  the  diminution  of  pressure, 
the  running  down  of  the  tension,  but  this  diminished  head 
of  pressure,  instead  of  being  concentrated  in  a  small  area 
in  which  it  would  still  be  capable  of  doing  good  service, 
is  distributed  over  all  the  regions  of  the  nervous  system, 
and  affords  to  each  a  miserably  inadequate  supply.  Hence 
it  is  that,  for  the  production  of  this  feeling  of  wretchedness 
under  normal  circumstances,  wakefulness  is  a  necessary  con- 
dition. And  hence  it  is  that  melancholia,  being  but  an 
exaggeration,  prolongation,  and  intensification  of  these 
normal  circumstances,  is  invariably  accompanied  by  wake- 
fulness. Night  after  night,  and  night  after  night,  these 
unfortunate  beings  get  either  no  sleep,  or  a  sleep  which  is 
measured  rather  by  minutes  than  hours,  and  which,  even 
when  gained,  is  of  the  lightest  character,  involving  in  its 
quiescence  not  a  great  depth  of  the  nervous  system,  but 
a  few  only  of  the  higher  layers,  and  leaving  the  remainder 
in  futile  and  exhausting  activity.  The  wakefulness  has  not 
the  accompaniments  of  restlessness  and  noise  that  accom- 
pany the  wakefulness  of  mania,  and  is  therefore  less  pro- 
minent and  less  frequently  recognized,  but  it  is  constant 
in  its  occurrence. 

Depression  of  spirits,  delusion,  torpor  of  conduct,  torpor 
of  nutrition  and  bodily  processes,  and  wakefulness — such  are 


THE   FORMS   OF    INSANITY.  347 

the  classical  manifestations  of  melancholia,  and  all  of  them 
may  be  accounted  for  by  considering  the  condition  an  exag- 
geration of  that  which  accompanies  every  wakeful  night, 
by  regarding  them  as  the  outcome  of  a  diminution  in  the 
tension  of  the  nervous  energy. 

Such  being  the  nature  of  melancholia,  the  treatment 
appropriate  for  it  becomes  obvious.  We  must  endeavour 
to  procure  sleep,  to  accelerate  and  re-vivify  the  process 
of  nutrition,  and  to  raise  the  tension  of  the  nervous  energy. 

The  measures  that  should  be  taken  to  procure  sleep  are 
too  long  to  set  forth  here  in  full.  This  much  may  be  said  : 
no  attempt  should  be  made  to  procure  sleep  by  means  of 
drugs  ;  certainly  not  until  all  other  means  have  failed.  Sleep 
so  procured  has  never  the  efficacy  of  sleep  that  is  brought 
about  by  more  natural  methods  ;  usually,  large  and  even 
dangerous  doses  of  soporific  drugs  have  to  be  given  before 
sleep  can  be  procured,  and  it  not  unfrequently  happens  that 
by  no  amount  of  the  drug  that  can  be  given  will  sleep  be 
obtained.  I  have  seen  more  than  one  patient,  the  sufferer 
from  persistent,  obstinate  insomnia,  dosed  with  opium,  and 
more  opium,  and  still  more  opium,  until  he  has  died  with 
the  symptoms  of  opium-poisoning  without  ever  going  to 
sleep.  The  way  to  procure  sleep  is  to  observe  the  hygiene 
of  sleep  ;  to  get  the  body  into  such  a  state,  and  to  place 
it  under  such  conditions  and  circumstances,  that  sleep  is  a 
natural  and  inevitable  result  ;  but  not  to  give  dose  after 
dose  of  narcotics.  I  have  seen  patients  who  had  not  slept 
for  many  days,  and  who  had  taken  incredible  quantities 
of  morphia,  bromide  of  potassium  and  chloral,  fall  into 
a  sound  sleep  in  a  few  hours  when  all  these  drugs  were 
stopped,  and  what  I  call  the  hygiene  of  sleep  had  been 
observed,  and  sleep  for  sixteen  hours  at  a  stretch. 

If  in  a  case  of  melancholy  we  can  procure  natural  sleep,  we 

at  once  arrest  the  expenditure  of  energy  in  the  higher  nerve 

regions  and  promote  the  process  of  re-storage  ;  hence  when 

the   patient  awakes  he  will  wake  with  his  nervous  system 

in    better   condition,    with   more   energy  in    store,  with   a 


34^  SANITY   AND   INSANITY. 

greater  tension  of  energy,  and  generally  in  better  condition. 
It  is  essential,  of  course,  that   the  sleep  should  be  accom- 
panied not  only  by  a  suspension  of  expenditure  of  energy, 
but  by  a  renewal  and  invigoration  of  the  process  of  storage. 
This  we  cannot  do  directly,  but  we  can  do  much  indirectly 
by  taking  measures  to  promote   the   activity  of   nutrition 
throughout  the  body,  so  that   in  this  general  renewal  the 
cerebral    molecules  may   share.     In   melancholia  the  blood 
is  always   impoverished.     Since,  owing  to  the  languid  cha- 
racter of  the  nutritive  processes,  hunger  is  not  felt,  or  but 
little  felt,  food  is  taken  in  but  small  quantities  or  not  at  all, 
and  hence  the  blood  is  always  poor  in  nutriment.     It  will 
occasionally  happen  that  melancholic  persons  die  of  starva- 
tion,  not   from   wilfully  refusing   their   food   with    suicidal 
intent,  but  simply  because  they  never  feel  hunger,  and  never 
represent  to  themselves  the  consequences  of  abstinence,  until 
the  brain  has  become  so  wasted  and  atrophied  from  deficient 
nourishment  that  no  representation  of  consequences  is  any 
longer  possible.     If,  under   such  circumstances,  we  compel 
the   individual    to    take   food  ;    if  we   cram   him    with   an 
abundance  of  nutritious  material,  the  blood  which  bathes 
his   tissues  becomes  rich  in   pabulum,  and  of  the  pabulum 
so  presented  the  tissues  cannot  fail  to  assimilate  some.    Now 
if  we  enforce  a  measure  of  exercise,  we  place  the  tissues 
in  a  state  in  which,  physiologically  and  naturally,  they  have 
an  increased   inclination    to  assimilate    pabulum   from   the 
blood  ;    and  if  we  insure  that,  after  this  enforced  exercise, 
the  hungry  tissues  have  a  rich  store  of  pabulum  presented 
to  them  in  the  blood,  they  cannot  fail  to  assimilate  some. 
The    process    once     started,    the    unaccustomed    habit    of 
feeding  once  again  resumed  by  the  wasted  tissues,  it  is  not 
difficult  to  maintain  the  habit  and  to  restore  their  integrity. 
With  increased   activity  of  nutrition  going  on  throughout 
the  body,   with   increased   power   in  the  heart's    action,  in- 
creased pressure  in  the  blood-vessels,  increased  richness  in 
the  blood  circulating  in  them,  the  tissue  of  the  brain  is  sub- 
jected to  so  strong  an  impulse  toward  re-invigoration  that 


THE    FORMS    OF    INSANITY.  349 

it  can  scarcely  resist.  Its  rnolecules  also  begin  to  share 
in  the  general  redintegration,  and  when  once  the  process 
gets  a  start  it  is  continued  with  less  difficulty.  The  resump- 
tion of  activity  in  the  nutritive  processes  tends  in  two  ways 
to  remove  the  symptoms  of  melancholia.  By  restoring  to 
the  cerebral  molecules  their  normal  powers,  it  produces 
directly  an  increase  of  the  tension  of  the  nerve  currents, 
and  this  increases  the  activity  of  the  body  ;  and  this  general 
increase  in  the  activity  of  all  processes  throughout  the  body 
is  reflected,  in  the  manner  already  set  forth,  in  the  highest 
nerve  centres,  and  is  consequently  accompanied  by  a  modi- 
fication— an  exaltation  —  of  the  coen^sthesis.  The  feeling- 
of  misery  gives  way  to  a  feeling  of  well-being.  So  marked 
and  so  strong  is  the  connection  between  the  improvement 
of  nutrition  of  the  body  generally  and  the  disappearance 
of  the  melancholy,  that  it  has  been  recognized  from  time 
immemorial.  A  thousand  years  ago  Rhazes,  an  experienced 
physician,  wrote  as  the  result  of  his  experience,  "  Make 
a  melancholy  man  fat,  and  thou  hast  completed  the  cure." 

There  is  one  other  matter  which  must  be  referred  to  in 
connection  with  melancholia,  and  that  is  the  tendency  to 
suicide  which  so  often  accompanies  it.  Suicide  is  so  com- 
plete and  violent  a  reversal  of  the  strongest  and  most 
fundamental  of  instincts — the  instinct  of  self-preservation — 
that  its  origin,  and  the  frequency  of  its  occurrence,  are 
extremely  puzzling.  It  seems  as  if  in  this  instance  our 
faithful  master-key  would  fail  to  unlock  the  mystery — as 
if  no  germ  of  such  an  action  could  exist  among  the  normal 
tendencies  of  the  healthy  organism  ;  no  principle  of  action 
whose  exaggeration  could  produce  such  a  result  ;  and 
certainly  the  explanation  is  very  difficult. 

It  is  often  assumed,  not  only  by  the  verdicts  of  coroners' 
juries,  but  in  the  writings  and  speeches  of  thoughtful  men, 
that  a  person  who  commits  suicide  must  necessarily  be 
insane  at  the  time  of  the  act.  In  this  opinion  I  do  not 
share.  It  seems  to  me  that  a  man's  circumstances  may  be 
such  that  he  may,  upon  careful  and  comprehensive  review 


350  SANITY   AND   INSANITY. 

of  them,  deliberately  conclude  that  life  is  not  worth  living, 
and  that  it  is  better  to  seek  annihilation,  or  to  take  the 
chance  of  happiness  or  unhappiness  in  a  future  life,  than 
to  submit  to  certain  and  extreme  misery  in  this.  Suppose 
that  a  man  is  subject  to  a  combination  of  adverse  circum- 
stances, that  his  wife  has  run  away  from  him,  his  daughters 
disgraced  him,  his  sons  have  robbed  him,  that  his  business 
is  a  failure,  and  that  he  is  afflicted  with  some  horrible  and 
incurable  disease.  Who  will  say  that,  for  a  man  so  situated, 
to  shorten  the  poor  and  miserable  remnant  of  life  remain- 
ing to  him  is  an  act  of  insanity  ?  He  has  to  take  his  choice 
of  evils.  Even  granting  that  by  choosing  to  put  an  end  to 
himself,  to  throw  down  his  fardel  and  refuse  any  longer 
to  grunt  and  sweat  under  a  weary  life,  he  chooses  wrongly 
and  unwisely,  yet  does  the  wrong  and  unwisdom  of  such  a 
course  amount  to  insanity  ?  Surely  not.  If,  then,  there  be 
circumstances  which  may  render  the  act  of  suicide  a  natural 
and  ready  way  out  of  intolerable  misery,  it  is  easy  to  under- 
stand that  there  may  arise  in  melancholia  a  state  of  mind 
which  is  in  every  respect  equivalent  to  that  which  would 
normally  exist  in  such  circumstances  ;  and  that  the  way  out 
of  a  misery  which  is  autogenetic,  and  does  not  correspond 
with  or  depend  on  adversity  of  circumstances,  may  be  the 
same  as  that  out  of  a  misery,  the  same  in  degree,  which 
is  justified  by  the  circumstances  in  which  the  organism  is 
placed.  There  may  be  no  justification  in  his  circumstances 
for  the  misery  which  the  melancholy  man  experiences,  but 
his  misery  is  as  acute,  as  real,  as  profound  as  that  of  the 
man  whose  circumstances  are  extremely  adverse  ;  nay,  there 
is  no  such  misery  as  that  of  melancholia  ;  and  under  the 
pressure  of  this  feeling  suicide  may  be  the  natural  and 
quasi-normal  course  to  take.  Here,  then,  a  large  class  of 
suicidal  cases  receives  an  explanation  on  grounds  which 
import  no  new  principle  of  action  into  human  motives,  and 
which  harmonize  with  the  general  course  of  human  nature. 

It  must  be   admitted,   however,  that  a  large  proportion 
of  the  persons  who  are  suicidally  disposed  do  not  exhibit 


THE    FORMS    OF    INSANITY.  35 1 

the  signs  of  extreme  misery.  All  of  them,  indeed,  are 
melancholic  to  a  certain  degree  or  at  certain  times,  but 
in  many  cases  the  taint  of  melancholia  is  so  slight,  or  so 
seldom  present,  that  it  is  very  diflBcult  to  assign  the  act  to 
extremity  of  misery.  In  a  certain  proportion  of  cases,  the 
suicide,  while  associated  with  melancholia,  is  yet  not  directly 
the  outcome  of  the  feeling  of  extreme  misery,  but  is  the 
logical  consequence  of  some  delusion.  Thus,  I  have  known 
a  man  of  wealth,  who  upon  quitting  business  became 
subject  to  acute  melancholia  with  delusions  of  poverty, 
commit  suicide  in  order  to  save  his  relatives  from  the 
burden  of  supporting  him.  In  many  cases  a  delusion  will 
be  found  if  diligently  sought  for,  but  in  some  cases  the 
motive  of  the  suicide  remains  inexplicable.  Of  all  the 
tasks  of  the  alienist  physician  none  is  more  difficult,  of 
all  his  heavy  responsibilities  none  is  more  onerous,  than 
that  of  determining  when  the  tendency  to  suicide  in  any 
individual  case  has  so  far  subsided  as  to  allow  of  the  patient 
being  restored  to  home,  to  friends,  to  society,  and  to  liberty. 
A  patient  is  admitted  to  an  asylum  in  deep  melancholia  ; 
he  improves  in  health,  he  becomes  cheerful,  he  becomes 
active,  his  delusions  subside  ;  he  says  that  he  feels  better, 
that  his  former  fancies  have  departed,  that  he  recognizes 
their  falsity.  He  is  watched  for  days  and  weeks,  and  as  his 
improvement  is  maintained  and  he  seems  quite  recovered, 
he  is  allowed  to  go  home.  Next  morning  he  is  found 
hanging  from  a  gas-bracket.  Such,  Avith  variations  in 
non-essentials,  is  the  history  of  scores  of  cases.  Nothing 
is  more  difficult  than  to  tell  when  the  tendency  to  suicide 
has  faded  out.  The  patient  seems  well,  seems  cheerful, 
happy,  and  active.  His  friends  are  clamouring  for  his 
discharge.  The  basest  and  most  sordid  motives  are  attri- 
buted to  his  medical  custodian  for  his  caution  and  prudence. 
At  length  he  yields  ;  the  patient  is  discharged,  and  forth- 
with commits  suicide.  Then  is  the  wrath  of  his  friends 
more  bitter  than  ever  against  the  doctor  who,  at  their  own 
persistent   solicitation,   gave  the  patient   the  chance  of  de- 


352  SANITY   AND   INSANITY. 

stroying  himself.  Then  a  coroner's  jury  gravely  censures 
the  doctor  for  his  AA'ant  of  care,  forethought,  and  skill. 
Cases  have  occurred  in  which  it  has  appeared  that  a  patient 
has  actually  been  able  to  sham  a  recovery,  to  assume  a 
cheerfulness  that  he  did  not  feel,  in  order  to  gain  his 
liberty,  and  with  his  liberty  the  means  of  destroying 
himself. 

How  are  we  to  account  for  such  cases — for  the  persistence 
of  the  tendency  to  suicide,  which  is  an  outgrowth  and,  as 
it  were,  a  non-essential  excrescence  on  the  fungus  of  melan- 
cholia, when  the  more  constant  and  more  fundamental 
manifestations  of  melancholia  have  disappeared  ?  The  pro- 
blem is  an  extremely  difficult  one,  but  its  solution  will 
probably  be  found  in  the  following  considerations.  The 
recovery  from  melancholia  is  often  interrupted  by  fits  of 
depression,  which  occur  at  varying  intervals  and  with 
varying  degrees  of  severity.  The  suicidal  impulse  may 
arise  during  an  unexpected  relapse  of  this  nature,  which, 
but  for  the  untoward  termination,  would  have  been  of  a 
temporary  character.  This  explanation  is  an  obvious  one, 
and  I  am  bound  to  say  that  it  is  one  Avhich  is  not  very 
satisfactory,  for  the  fits  of  depression  which  interrupt  the 
recovery  from  melancholia  are  not  usually  extremely  severe. 
The  true  explanation  is  probably  to  be  found  in  considera- 
tions of  a  very  different  character. 

The  following  cases  were  related  by  Dr.  Hughlings 
Jackson  in  his  recent  Address  in  Aledicine  to  the  British 
Medical  Association  : — A  man  was  clasping  a  vessel  con- 
taining an  explosive,  when  the  vessel  exploded  and  blew 
his  hand  off.  As  is  often  the  case,  he  retained  a  phantom 
hand  ;  that  is  to  say,  he  had  feelings  as  if  the  hand  were 
still  there  ;  and  this  phantom  hand  appeared  to  be  always 
in  the  position  of  grasping  the  vessel.  Another  man  had 
a  sudden  attack  of  brain  disease,  by  which  he  lost  his  speech. 
The  only  words  which  he  remained  able  to  utter  were, 
"Come  on,"  or  "Come  on  to  me."  He  was  a  signalman, 
and  it  is  presumed  that  in  the  course  of  his  duty  he  was 


THK    FORMS   OF    INSANITV.  353 

Uttering,  or  was  about  to  utter,  these  words  when  his  seizure 
took  place.  A  soldier,  while  "  numbering  off,"  had  a  fit. 
Afterwards  he  had  many  fits,  and  in  each  one  he  would 
begin  to  count.  In  another  case,  a  woman  fractured  her 
skull  while  laying  oilcloth  ;  and  during  the  stupor  that 
preceded  her  death,  she  kept  manipulating  the  counterpane 
of  her  bed  as  if  laying  oilcloth,  and  would  desist  for  a  time 
when  told  that  it  was  properly  laid.  All  these  cases  re- 
semble one  another  in  this  :  that  in  each  there  was  either 
prolonged  persistence,  or  more  or  less  frequent  recurrence, 
of  a  form  of  activity  that  should  have  been  temporary  only  ; 
and  in  each  case  the  activity  was  renewed  without  any 
appropriateness  to  the  circumstances  in  which  it  occurred. 
Hence  we  are  impressed  with  this  quality  in  the  nervous 
system — the  quality  of  gaining  a  habit  of  renewing  a  certain 
activity,  without  reference  to  the  appropriateness  of  that 
activity  to  the  circumstances.  It  is  possible  that  the  ten- 
dency to  suicide  may  in  the  same  manner  be  fixed,  and 
be  impressed  with  a  habit  of  recurrence  at  odd  times  and 
without  provocation  from  circumstances.  It  is  true  that 
in  all  the  four  cases,  the  fixation  of  the  temporary  state  was 
brought  about  by  a  sudden  shock  of  some  kind  to  the 
nervous  system,  and  that  in  the  cases  of  recurring  suicidal 
impulse  no  shock  is  traceable  ;  but  we  do  not  know  that 
shock  is  the  only  fixing  agent  that  can  produce  this  result 
on  the  nervous  arrangements.  It  seems  probable  that  this 
principle  will  account  for  the  apparently  causeless  recurrence 
of  the  suicidal  impulse  in  those  who  have  to  all  seeming 
recovered  from  melancholia.  But  there  remain  a  number 
of  cases  still  unaccounted  for,  cases  in  which  suicide  is 
attempted  by  persons  who  are  not  very  deeply  sunk  in 
melancholia,  or  by  persons  who  are  rather  demented  than 
melancholic,  who  attempt  suicide  without  appearing  to  be 
fully  aware  of  what  they  are  doing  ;  or  by  persons  whose 
malady  ordinarily  partakes  more  of  the  nature  of  mania 
than  that  of  melancholia.  The  explanation  of  such  cases 
is  at  first  sight  extremely  difficult,  bat  the  difficulties  fade 

24 


354  SANITY    AND    INSANITY. 

away  when  we  regard  such  acts  as  exaggerated  instances  of 
acts  that,  if  not  quite  normal,  are  at  least  very  common. 

The  tendency  to  self-injury  is  very  widely  spread  in  the 
human  race,  and  must  therefore,  no  doubt,  be  very  deeply 
seated.  The  spirit  of  self-sacrifice,  to  which  allusion  has 
already  been  made,  is  but  self-injury  on  a  higher  level  than 
that  of  actual  physical  mutilation.  The  principle  on  which 
it  depends  is  precisely  the  same,  although  the  manifestation 
takes  a  different  form.  We  have  seen  how  this  spirit  of 
self-sacrifice  is  intimately  connected  with  the  sexual  function, 
of  which,  indeed,  it  is  an  essential  and  integral  part;  and  hence 
we  are  not  surprised  to  find  that  suicide,  a  gross  and  brutal 
form  of  self-sacrifice,  is  frequently  due  to  sexual  promptings. 
When  a  silly  girl  jumps  into  the  water  because  her  lover 
has  wearied  of  her,  it  is  not  the  mere  disappointment  and 
grief  that  prompt  her  to  the  deed.  By  the  fact  of  being 
in  love  she  signifies  that  the  willingness — nay,  the  longing — 
to  allow  herself  to  suffer  injury  for  the  ultimate  produc- 
tion of  offspring,  has  descended  to  her  from  an  interminable 
line  of  ancestry,  throughout  which  the  example  of  the  gre- 
garine  has  been  followed,  in  principle,  from  generation  to 
generation  without  a  single  exception.  Offspring  cannot  be 
produced  by  any  organism  without  some  sacrifice  on  the 
part  of  the  parent,  especially  of  the  female  parent,  and  the 
readiness  to  submit  to  sacrifice  is  an  integral  part  of  the 
sexual  attitude.  This  readiness  to  sacrifice  varies  much  in 
different  individuals,  though  present  to  some  extent  in  all  ; 
and  we  have  already  seen  that  a  quality  which  varies  much 
within  the  limits  of  the  normal  is  especially  prone  to  ex- 
ceed the  limits  of  the  normal  both  in  excess  and  in  defect. 
From  the  fact  that  the  amount  of  self-sacrifice  of  which 
lovers  are  capable  varies  so  widely  in  different  cases,  we 
might  be  confident  a  priori  that  cases  would  occasionally 
occur  in  which  the  proneness  to  sacrifice  self  would  be  in 
excess. 

Self-sacrifice  occurs  in  two  fornis.  One  form  is  when  it 
is  undertaken  as  the  only  means  of  conferring  benefits  on 


THE   FORMS   OK    INSANITY.  355 

Others,  as,  for  instance,  when  a  landed  proprietor  deprives 
himself  of  the  rent  of  a  plot  of  land  in  order  to  give  his 
poorer  neighbours  the  benefit  of  a  park  and  a  playground  ; 
or  when  a  Winkelreid  gathers  the  points  of  his  enemies' 
lances  in  his  own  breast,  in  order  to  make  a  breach  for  his 
comrades  to  enter  ;  or  when  a  Father  Damien  voluntarily 
cuts  himself  off  from  society,  and  devotes  himself  to  a 
lingering  and  loathsome  disease,  in  order  to  minister  to 
a  forlorn  and  neglected  section  of  his  fellow-creatures. 
Such  forms  of  self-sacrifice,  in  which  the  amount  of  hard- 
ship inflicted  on  self  is  no  more  than  is  necessary  to  obtain 
the  benefits  desired  for  others  are  altogether  normal,  praise- 
worthy, and  admirable,  and  are  examples  of  the  highest 
development  to  which  human  feeling  and  human  action  can 
attain. 

Far  otherwise  is  it  with  the  other  class  of  cases,  which 
are  common  enough,  in  which  self-sacrifice  is  inflicted  and 
endured,  not  to  enable  others  to  obtain  benefits,  but  for  its 
own  sake, — for  the  satisfaction  derived  from  the  conscious- 
ness that  suffering  is  being  endured.  Such  cases,  far  from 
being  examples  of  piety,  of  patriotism,  or  of  benevolence, 
are  simply  cases  of  perverted  sexual  instinct.  That  at  the 
root  of  the  function  of  reproduction  lies  the  necessity  of 
self-sacrifice  has  already  been  demonstrated,  and  that  the 
sexual  desire  to  sacrifice  self,  when  denied  its  legitimate 
outlet  and  gratification,  will,  after  blind  strivings  and 
gropings,  find  its  expression  in  some  form,  however  strange 
and  superficially  remote  from  sexuality,  has  also  been  shown. 
When  a  mother  goes  without  sugar  in  her  tea  in  order  that 
her  child  may  have  a  double  portion,  she  is  sacrificing  her- 
self for  the  sake  of  her  offspring  ;  she  is  following  her 
gregarine  ancestor  afar  off  ;  she  is  satisfying  a  normal 
l)arental  instinct  in  a  normal  way  ;  and  her  conduct  is 
altogether  praiseworthy.  But  when  she  deprives  herself 
of  sugar,  not  for  the  sake  of  giving  it  to  another,  but  merely 
that  she  may  experience  the  self-righteous  feelings  of  martyr- 
dom, she  is  gratifying  an  abnormal  feeling  of  sexual  origin 


356  SANITY   AxND   INSANITY. 

in  an  irregular  manner.  She  is  prompted  by  the  same 
motives  that  wield  the  fiagellum  of  the  monk  and  that 
raised  the  pillar  of  Stylites  ;  and  more  than  this,  her  motive 
is  precisely  that  of  the  suicide.  She  desires  to  injure  herself 
for  the  sake  of  injuring  herself,  in  order  to  satisfy  her  sexual 
instinct  of  self-sacrifice.  Self-sacrifice  for  self-sacrifice  sake, 
whether  it  take  the  form  of  unsweetened  tea,  of  monastic 
vows,  or  of  a  cut  throat,  is  always  of  sexual  origin,  and  is 
merely  an  aberrant  manifestation  of  the  tendency  to  injury 
of  self  which  accompanies  the  production  of  offspring. 
Among  the  forms  in  which  this  sexual  desire  of  self- 
sacrifice  finds  expression  is  that  of  suicide. 

Hence  we  are  not  surprised  to  find  that  a  large  proportion 
of  cases  of  suicide  are  directly  connected  with  the  sexual 
function.  The  subjects  of  them  are  lovers,  either  actual  or 
potential  ;  that  is  to  say,  they  are  young  people  who  ha\  e 
been  disappointed  in  love,  either  by  the  desertion  of  their 
lovers,  or  it  may  be  by  the  non-appearance  of  a  lover.  At 
any  rate,  they  are  persons  of  the  age  at  which  love  is  most 
fervent — adolescents.  Another  large  contingent  of  suicides 
are  those  whose  tendency  is  connected  with  the  sexual 
function  indirectly  through  religion.  They  are  the  sub- 
jects of  religious  mania,  and  practically  come  into  the  same 
class  as  the  last. 

There  is  another  class  in  which  the  act  of  suicide  has  a 
different  origin.  It  has  to  be  remembered  that,  rare  and 
morbid  as  the  act  of  suicide  is  with  us,  there  are  people  with 
whom  it  is  comparatively  common,  and  in  whom  it  is  com- 
paratively a  natural  and  normal  act.  Among  the  Chinese,  if 
a  man  wishes  to  inflict  upon  his  enemy  a  deadly  injury,  he 
disembowels  himself  on  that  enemy's  doorstep.  The  act  of 
inflicting  an  injury  upon  one's  self  in  order  to  be  revenged  on 
some  one  else  is  common  among  various  lower  races,  but 
that  it  is  not  confined  to  these  the  following  cases  will 
show  : — When  I  was  house-surgeon  at  the  London  Hospital 
it  happened  on  several  occasions  that  a  woman  came  in  with 
a  more  or  less  severely  lacerated  hand  ;  and  on  being  asked 


THE    FORMS    OF    INSANITY.  357 

the  usual  questions  as  to  the  origin  of  the  injury,  she  would 
explain  that  she  and  her  husband  were  having  some  words 
and  that  he  aggravated  her  so  that  she  put  her  hand 
through  the  window.  Upon  inquiry  I  was  never  able  to 
ascertain  whether  the  act  of  dashing  the  hand  through  the 
glass  was  done  with  the  intention  of  injuring  herself,  or 
of  annoying  her  husband  by  putting  him  to  the  incon- 
venience and  expense  of  the  broken  glass.  Such  inquiries 
evidently  appeared  to  the  patient  foolish  and  uncalled  for. 
They  could  give  no  account  of  the  motive  of  the  act,  and 
evidently  wondered  that  any  motive  should  be  sought.  To 
them  it  was  as  natural  and  facile  a  mode  of  retaliating  upon 
the  provocation,  as  if  they  had  pulled  the  husband's  hair  or 
scratched  his  face.  If  they  had  done  either  of  these  two 
things,  the  fact  that  they  had  been  provoked  to  do  it  would 
have  been  a  sufficient  explanation  ;  and  to  them  the  same 
explanation  was  equally  sufficient  of  the  act  of  nutting  the 
hand  through  the  glass. 

The  fact  seems  to  be  that  the  normal  expression  of  rage 
is  to  injure  some  one.  If  the  person  who  aroused  the  rage 
is  handy,  then  to  attack  and  injure  him  gives  the  satisfaction 
needed.  If  he  is  inaccessible  or  not  obnoxious  to  attack, 
then  the  rage  may  find  expression  in  the  injury  of  a  third 
party,  as  in  the  classical  cases  of  Captain  Absolute  and  Mr. 
Fag  in  "  The  Rivals."  But  it  seems  that  when  the  appetite 
for  destruction  is  once  aroused,  it  will  find  satisfaction  in 
the  injury  of  anything — even  of  inanimate  things,  or  of  the 
enraged  individual  himself.  Thus,  one  man  in  a  rage  will 
attack  the  person  who  has  injured  him,  another  will  smash 
the  furniture,  and  a  third  will  put  his  own  hand  through 
the  glass,  or  cut  his  throat,  or  disembowel  himself. 

The  act  of  suicide,  then,  may  originate  in  one  of  several 
ways — may  be  prompted  by  one  of  several  motives.  It  may 
be  the  expression  of  a  feeling  of  misery  so  intolerably  severe 
that  it  can  be  no  longer  borne — that  death  is  deliberately 
preferred  to  so  miserable  a  life.  It  may  be  the  outcome  of  a 
delusion  which,  if  it  were  true,  w'ould  go  far  to  justify  the 


358  SANITY    AND    INSANITY. 

act,  as  where  a  man  kills  himself  in  the  belief  that  his  wife 
and  children  are  dead,  and  that  their  spirits  are  urging  him 
to  join  them.  It  may  be  an  exaggeration  to  the  extreme  of 
the  desire  for  sacrificing  self,  which  is  one  of  the  fundamental 
characters  of  sexual  activity  ;  or,  finally,  it  may  be  an  ex- 
pression of  blind  rage,  the  outcome  of  those  destructive 
activities  with  which  we  shall  have  more  to  do  hereafter. 
Whichever  of  these  origins  the  act  may  have,  the  imme- 
diate occasion  of  it  may  be  a  delusion  or  an  hallucination  ; 
e.g.^  the  suicide  may  have  imagined  that  the  Deity  has 
commanded  him  to  sacrifice  himself,  or  may  have  heard 
an  imperious  voice  exhorting  him  with  irresistible  vehe- 
mence to  do  so. 


CHAPTER  XIV. 

THE    FORMS    OF    INSANITY    (CoutiniCed). 

Exaltation. 

The  second  alteration  of  self-consciousness  occurs  when  the 
tension  of  the  energy  that  circulates  in  the  visceral  and  nutri- 
tive moiety  of  the  nervous  system,  is  not  diminished,  but 
increased.  Under  such  circumstances  the  symptoms  will  be 
in  all  respects  the  contrary  of  those  described  in  the  last 
chapter.  Exaltation  will  be  substituted  for  depression,  and 
exaggeration  for  diminution. 

When  the  tension  of  the  nervous  energy  is  reduced,  the 
reduction  in  the  tension  is  not  usually  confined  to  the  visceral 
moiety  of  the  nervous  system,  although  it  often  affects  this 
moiety  with  preponderant  severity  ;  and  the  same  is  the 
case  when  the  tension  is  increased.  The  heightened  tension 
is  not  usually  confined  to  this  part  of  the  nervous  system, 
but  it  does  usually  affect  one  part  more  prominently  than 
the  other.  So  that  in  some  cases  the  main  symptom  is 
exaggerated  activity  in  the  conduct,  while  in  other  cases  the 
main  symptom  is  exaggerated  activity  of  the  nutritive  pro- 
cesses ;  but  whichever  symptom  is  the  more  prominent,  some 
degree  of  the  other  usually  accompanies  it. 

Exaggeration  of  the  tension  of  nerve  energy  to  a  morbid 
entent  occurs  in  practically  only  two  conditions — in  drunken- 
ness and  in  general  paralysis  of  the  insane  ;  which  latter  has 
all  the  appearance  of  a  permanent,  progressive,  and  incurable 
drunkenness.  While  defect  in  the  tension  may  exist  without 
appreciable  loss  of  function  in  any  local  area,  and  hence  a 


360  SANITY   AND   INSANITY. 

simple  depression  of  mind  may  exist  without  the  accompani- 
ment of  any  delusion,  or  even  of  any  appreciable  impairment 
of  the  integrity  of  the  other  mental  processes  ;  exaggeration 
of  the  nervous  tension,  as  a  clinical  fact,  occurs  seldom,  and 
then  briefly,  without  some  impairment  of  intelligence.  It 
may  be,  in  the  very  early  stage  of  drunkenness,  when  as  yet 
there  is  only  an  increased  flow  of  blood  to  the  higher  nerve 
regions,  and  before  the  benumbing  eifect  of  the  alcohol  has 
had  time  to  make  itself  felt,  that  the  increase  of  blood  supply 
causes  an  increased  emission  of  nerve  energy,  and  so  a 
heightened  tension  in  the  regions  affected,  without  any 
appreciable  loss  of  function  in  even  the  highest  regions. 
When  this  occurs,  there  is  for  the  time,  and  usually  it  is  for 
but  a  short  time,  not  only  an  exaltation  of  the  sense  of  well- 
being,  but  an  actual  increase  of  intellectual  power.  The 
individual  is  not  only  jovial  and  companionable,  self-satisfied 
and  happy,  but  he  is  then  even  witty  ;  his  conversational 
powers  are  exalted.  The  hesitating  man  becomes  fluent,  the 
dull  man  bright,  the  slow  man  quick,  the  serious  man  sees  a 
joke  with  an  unwonted  readiness  of  appreciation.  So,  too, 
in  the  earliest  stages  of  general  paralysis  it  occasionally 
happens  that  the  patient  gives  evidence,  not  only  of  enhanced 
self-complacency  and  increased  vigour,  but  of  actual  increase 
of  ability  over  his  usual  standard. 

Such  periods  of  simple  exaltation  are  not,  however,  of  long 
duration.  Soon  the  very  increase  in  the  blood  supply  which 
produces  the  heightened  cerebral  activity  of  the  man  M'ho  is 
elevated  by  drink,  provides  additional  facility  for  the  action 
of  the  alcohol,  which  is  present  in  the  blood,  to  act  en  the 
higher  nerve  regions  ;  and  soon  the  flush  of  blood,  which  is 
the  earliest  phenomenon  in  inflammation,  is  succeeded  by 
the  deterioration  of  tissue  that  inflammation  produces  ;  the 
highest  nerve  regions  succumb  to  the  damaging  influence, 
and  while  the  enhancement  of  tension  and  the  exaggeration 
of  action  continue,  they  are  conducted  on  loM-er  levels,  and 
result  in  manifestations  of  increased  vigour,  it  is  true,  but  of 
vigour  misapplied  and  misdirected. 


THE   FORMS   OF   INSANITY.  36 1 

The  way  in  which  the  enhancement  of  tension  manifests 
itself  depends  on  its  extent  and  on  its  seat.  When  it  pre- 
ponderates in  the  visceral  circulation  of  nerve  energy  there 
results  an  enhancement  of  the  vigour  with  which  the  bodily 
processes  are  carried  on.  Digestion,  secretion,  assimilation, 
nutrition,  are  all  conducted  with  increased  efficiency.  The 
improvement  in  digestion,  which  is  brought  about  by  the 
consumption  of  wine  with  dinner,  is  well  known.  Many 
persons  of  weak  digestion  are  unable  to  digest  their  food 
unless  it  is  accompanied  with  wine  ;  and  in  such  cases  the 
wine  acts  by  enhancing  the  tension  of  the  nerve  energy 
going  to  the  abdominal  viscera. 

Nothing  is  more  remarkable  in  the  state  of  the  general 
paralytic  than  his  splendid  muscular  condition.  Although, 
owing  to  the  defect  in  his  highest  nerve  regions,  his  conduct 
may  have  deteriorated  so  much  as  to  be  almost  abolished  ; 
although,  OAving  to  defect  of  his  middle  nerve  regions,  his 
movements  may  be  so  much  impaired  that  he  cannot  lift  his 
food  to  his  mouth  without  spilling  it,  nor  stand  without 
support  ;  yet,  from  the  continuous  flow  of  high  tension 
currents  into  his  muscles,  they  are  maintained  in  as  high  a 
state  of  nutrition,  as  hard,  as  firm,  and  as  vigorous  as  if  he 
were  in  training  for  a  race. 

With  this  enhancement  of  tension  of  the  energy  in  the 
higher  regions  of  the  visceral  circulation,  goes  a  correspond- 
ing enhancement  of  the  feeling  of  well-being,  which  is  the 
mental  accompaniment  of  the  action  of  that  portion  of  the 
nervous  system.  After  a  few  glasses  of  wine,  the  bashful 
man  loses  his  diffidence  and  becomes  self-confident.  His 
self-confidence  is  based  upon  the  enhancement  of  his  appre- 
ciation of  his  own  qualities,  consequent  on  the  increase  in 
his  nervous  tension.  The  braggadocio  in  which  so  many 
tipsy  men  indulge  has  its  root  in  the  same  circumstance. 
Feeling  an  enhanced  consciousness  of  their  own  abilities, 
and  having  lost,  by  the  removal  of  the  highest  layers  of  their 
external  circulation,  the  due  appreciation  of  the  fitness  of 
expressing  themselves  modestly  and  with  reticence,  they  give 


362  SANITY   AND   INSANITY. 

full  expression  to  their  enhanced  self-appreciation,  and  brag 
to  excess.  That  their  self-laudation  is  the  honest  expression 
of  their  own  belief  in  their  own  powers,  appears  from  the 
fact  that  they  will  back  themselves  to  perform  prodigious 
feats,  and  will  even  attempt  them.  At  such  a  time  a  man 
will  offer  to  jump  over  the  table,  to  fight  overwhelming  odds, 
or  to  write  a  poem. 

In  general  paralysis,  as  the  enhancement  of  the  nervous 
tension  is  so  much  more  exaggerated,  so  the  vagaries  of  self- 
consciousness  are  much  more  extravagant.  While  the  tipsy 
man  will  content  himself  with  the  claim  to  be  considered  the 
strongest  man  in  the  room,  the  general  paralytic  considers 
himself  the  strongest  man  on  earth.  While  he  is  lying 
bedridden,  helpless,  incapable  of  dressing,  feeding,  or  helping 
himself,  he  will  boast  of  his  prodigious  muscular  power  and 
ability  :  that  he  can  lift  a  house,  drink  the  sea  dry,  beget  a 
hundred  children  in  a  night,  and  that  his  arms  and  legs  are 
miles  in  length. 

As  in  the  case  of  defect,  excessive  nervous  tension  is 
seldom  confined  to  one  system  of  nervous  circulation,  and  is 
usually  combined  with  local  losses  of  function  in  both. 
Hence,  in  conditions  of  exaltation,  we  usually  find  delusions 
of  self  combined  with  delusions  of  the  relation  of  self  to 
surroundings.  The  general  paralytic  beheves  not  only,  in 
spite  of  his  manifest  infirmities,  that  he  is  "  all  right,"  in 
splendid  health,  and  capable  of  boundless  activity  ;  but 
also,  in  spite  of  the  sordid  surroundings  of  a  workhouse,  he 
believes  himself  to  be  in  a  palace,  that  he  is  the  possessor  of 
untold  wealth,  that  he  owns  "  millions  and  millions  and 
millions,"  that  he  can  "  pave  the  streets  of  London  seven- 
teen feet  thick  with  diamonds,"  and  so  forth. 

Of  course  it  is  not  every  case  of  general  paralysis  which 
presents  delusions  so  exaggerated  as  these,  and  there  are 
many  cases  in  which  no  actual  delusions  can  be  elicited;  but  in 
even  the  least  exaggerated  case  there  is  a  quiet  contentment, 
a  buoyancy  of  mind,  a  general  state  of  happiness  and  feeling 
of  well-being,  which  are  in  striking  contrast  with  the  utter 


THE    FORMS    OF    INSANITY.  363 

wreck  of  bodily  and  mental  faculty,  and  which  render  this 
malady  one  of  the  saddest  to  witness,  as  it  is  undoubtedly 
the  least  painful  of  all  to  endure. 

The  increased  vigour  of  the  nutritive  processes,  and  the 
corresponding  enhancement  of  the  feeling  of  well-being,  are, 
as  might  be  expected,  not  the  sole  evidences  of  increase  in 
the  tension  of  the  nerve  energy.  When,  as  usually  happens, 
this  increase  of  tension  obtains  in  the  outer,  as  Avell  as  in 
the  inner,  circulation  of  'nerve  energy,  there  follows  an 
increase  in  the  vigour  of  the  action  of  the  individual  upon 
his  surroundings,  which  is  great  or  little  according  to  the 
amount  of  increase  in  the  nervous  tension,  but  which  is 
usually  considerable.  Nothing,  not  even  the  marked  self- 
complacency  and  arrogance  of  the  incipient  general  paralytic, 
is  more  strikingly  conspicuous  than  his  eager,  restless  activity. 
His  hours  of  sleep  are  abbreviated,  and  his  waking  hours, 
longer  though  they  are,  are  more  fully  employed,  are  more 
crowded  with  activity  than  ever  before.  His  bearing  and 
demeanour  are  eager  and  restless.  He  is  constantly  in 
motion,  and  his  walk  is  rapid  and  hurried.  He  meddles 
with  everything  that  he  comes  across  ;  he  writes  dozens 
of  unnecessary  letters  ;  he  talks  with  undue  vehemence, 
rapidity,  and  frequency,  and  at  undue  length.  He  laughs 
immoderately  and  on  insufficient  provocation.  There  is  an 
entire  absence  of  repose  about  him.  The  manifestations  of 
the  heightened  tension  of  the  nervous  energy  are  of  endless 
variety,  depending  as  they  do  for  their  form  upon  the 
amount  and  distribution  of  the  areas  of  the  higher  nerve 
regions  which  are  left  uncontrolled  and  unco-ordinated  by 
loss  of  the  regions  above  them. 

The  peculiarity  of  all  these  cases  is  that,  as  a  rule,  the 
character  and  degree  of  the  delusions  have  a  general 
relation  with  the  other  evidences  of  heightened  tension. 
The  greater  the  activity  of  the  visceral  nervous  processes, 
the  higher  the  self-appreciation  ;  and  when  we  are  able  to 
reduce  the  one,  a  corresponding  reduction  takes  place  in 
the  other.     Thus  to  a  patient  with  a  glorious  exaltation,  of 


364  SANITY   AND   INSANITY. 

a  most  jovial  and  smiling  aspect,  and  of  eager  and  incessant 
activity,  who  claimed  to  be  the  Almighty  Himself,  I 
administered  a  large  dose  of  bromide  of  potassium,  with 
the  effect  of  reducing  his  bodily  activity  to  comparative 
quiescence,  of  replacing  his  jovial  expression  by  one  of  mere 
placidity,  and  of  lowering  his  claim  for  honours  from  those 
due  to  the  Deity  to  those  due  to  the  Prince  of  Wales. 

While    delusions  of  grandeur  occur   most   commonly  in 
association  with  heightened  nervous  tension  and  increased 
feeling  of  well-being,  they  occasionally  occur  without  these 
accompaniments,  and  every  asylum  contains  quiet,  orderly, 
well-conducted   men  and  women,  whose  activity  is  not  in 
excess,  whose  appearance  and  demeanour  are  not  suggestive 
of  any  exaltation  of  self-consciousness  or  unjustifiable  feeling 
of  well-being,  who,  upon  a  short  acquaintance,  would  pass 
as    sane    beings,    but    who   cherish    delusions    of    personal 
grandeur.     Of  such  people,  some  lay  claim  to  royal  honours. 
One  is  Prince  of  Wales,  another  is  her  Majesty,  another  is 
a  Royal  Duke  and  Emperor  of  Universal  Dominion  ;  others 
aim  higher  still,  and  are  satisfied  with  nothing  short  of  the 
attributes  of  the  Saviour  and  of  the  Deity.     For  some  of 
these  cases  the  explanation    is   that   given  in  the  previous 
chapter   to  account  for  certain  cases  of  suicide.     They  are 
not  evidences  of  exalted  nervous  tension  now  existing,  but 
remanets  from  a  former  state  of  that  nature  which  has  now 
passed  away.     They  are  the  cicatrices  of  old  sores.     They 
are    conditions    which,    in    the    ordinary   course    of   things, 
should  have   been    temporary,  but    Avhich,   owing   to  some 
variation  in  the  nature  of  the  morbid   process,  have  become 
permanent.     Other  cases  of  this  nature  fall  into  the  follow- 
ing class. 

The  third  variety  of  alteration  in  the  ccensesthesis  occurs 

when,    without    any    important    alteration    in    the    general 

nervous  tension,  changes  take  place  in  the  highest  regions 

of  the  vnsceral  nervous  circulation,  of  the  same  character  as 

occur    in    the  other  moiety  of  the  nervous   circulation    in 


THE   FORMS   OF   INSANITY.  365 

ordinary  cases  of  delusion  of  the  relation  of  self  to  surround- 
ings.   We  have  seen  how,  in  dreams,  a  partial  and  perturbed 
activity  of  some  of  the  highest  nerve  regions  proceeds  simul- 
taneously with  the  suspension  of  activity  in  the  remainder  ; 
how  the  suspension  of  activity,  beginning    in  the   highest 
regions  of  all,  spreads  downward  with  an  irregular  progress, 
leaving,  here  and  there,  areas  outstanding  which  still  remain 
active ;    and     that    the    uncontrolled,     unbalanced,    unco- 
ordinated, uncombined  activity  of  these  isolated  areas,  has 
for  its  mental  counterpart  the  phenomena  of  dreaming,  and 
finds  its  outward  expression,  when  it  is  of  sufficient  intensity 
to   spread    downward    to   the    middle  regions  and    produce 
outward  expression,  in    somnambulism   and  somniloquence. 
So  long  as  this  irregular  remainder  of  active  areas  is  con- 
fined  to  that  part  of  the  nervous  system  which   regulates 
the  adjustment  of  self  to  surroundings,  so  long  the  delusions 
have  relation  to  this  adjustment,  and  fall  to  be  dealt  with 
presently  ;    but    when    the    areas    acting    thus    irregularly 
belong  to  the  highest  regions  of  the  visceral  and  nutritive 
circulation  of  nerve  energy,  then  the  corresponding  altera- 
tion of  consciouness  is  an  alteration  of  the  coenaesthesis,  and 
then  the  delusions  that  result  are  delusions,  not  primarily  of 
the  relation  of  self  to  surroundings,  but  are  delusions  of  the 
nature  of  self.     Often   this  irregular  failure  of  the  higher 
nerve  regions  of  the  visceral  circulation  is  associated  with 
alterations  in  the  nervous  tension,  which  give  to  the  mani- 
festations their  predominating  character,  and  then  the  case 
falls  in  one  of  the  categories,  already  considered,  of  melan- 
cholia  with   delusions,  or   exaltation  with    delusions.     But 
occasionally  there  is  a  simple  failure  without    conspicuous 
modification    of   tension,   and    then  there  are    delusions    of 
self  without  exhilaration  or  depression. 

The  conditions  upon  which  delusions  of  self  depend  are, 
however,  more  complicated  than  has  been  described.  The 
alteration  in  the  highest  regions  of  the  visceral  circulation 
produces  an  alteration  in  the  distribution  of  the  nerve 
currents  flowing  to  the  viscera, — an  alteration  in  the  distri- 


366  SANITY   AND   INSANITY. 

butioii  of  the  volume  and  pressure  of  the  nerve  energy. 
This  alteration  in  the  nerve  supply  produces,  of  course,  an 
alteration  in  the  manner  and  in  the  activity  with  which  the 
nutritive  processes  are  severally  carried  on  ;  and  this  altera- 
tion of  the  nutritive  processes  in  its  turn  modifies  the  flo^v 
of  the  return  currents  to  the  highest  nerve  regions,  and  is 
mirrored  both  in  their  action  and  in  the  state  of  the 
consciousness  of  self  which  accompanies  their  action.  Thus 
there  is  a  vicious  circle  of  morbid  errors.  The  altered 
nervous  supply  acts  on  the  tissues  and  modifies  their  nutri- 
tion ;  and  the  altered  tissues  react  on  the  nervous  system 
and  alter  its  Avorking.  Every  alteration  in  the  nutrition  of 
the  body  is  mirrored  in  the  higher  nervous  regions,  and  has 
its  attendant  alteration  of  consciousness;  but  not  every  such 
modification  of  nutrition  is  attended  by  delusion.  Only 
when  the  higher  nerve  regions  are  independently  disordered 
does  there  arise  delusion,  which  then  takes  its  form  from, 
and  is  referred  to,  the  locality  of  any  alteration  of  nutrition 
which  happens  to  be  going  on  at  the  time. 

At  the  outset  of  a  fever,  during  the  invasion  stage,  there 
is  a  profound  alteration  of  the  coensesthesis.  The  processes 
of  nutrition  going  on  within  the  body  are  greatly  altered. 
The  nerve  currents  set  up  by  these  processes,  and  flowing 
to  the  highest  nerve  regions,  are  greatly  modified  ;  and  the 
coenaesthesis,  or  feeling  of  self,  which  is  the  mental  accom- 
paniment of  the  wash  of  these  currents  on  the  shores  of 
the  highest  nerve  regions,  is  profoundly  altered.  Almost 
every  one  knows  the  feeling  of  malaise,  of  languor,  of  "  being 
ill,"  which  attends  the  invasion  stage  of  a  fever,  and  can 
testify  as  to  the  profound  alteration  which  then  takes  place 
in  his  ordinary  feelings  of  health  and  well-being.  But  yet 
this  alteration  of  coenaesthesis  is  not  necessarily  accompanied 
by  delusion.  The  feeling  is  attributed  correctly  to  its  actual 
cause,  and  no  delusion  arises.  In  order  for  a  delusion  to 
arise,  there  must  be  some  other  change — some  additional 
factor.  Supposing  that  a  man  attribute  his  feeling  of  malaise, 
not  to  the  invasion  of  a  fever,  but  to  possession  by  a  devil  : 


The  forms  of  insanity.  367 

the  feeling,  we  suppose,  is  the  same,  and  is  due  to  the  same 
alteration  of  bodily  processes,  but  the  ascription  of  this 
feeling  to  an  imaginary  and  impossible  cause,  is  due  to  some 
other  disorder  of  nervous  processes,  over  and  above  that 
arising  from  the  altered  incoming  currents.  It  is  necessary 
to  insist  upon  the  existence  of  this  additional  factor,  because 
the  existence  of  a  lesion,  at  the  place  to  which  a  delusion  is 
referred,  is  sometimes  considered  to  be  a  complete  and 
adequate  explanation  of  the  delusion.  If,  for  instance,  a 
man  has  a  delusion  that  his  bowels  are  completely  stopped  ; 
and,  upon  post-mortem  examination,  an  ulcer  of  the  bowels  is 
found,  it  is  considered  that  the  ulcer  accounts  for  the 
delusion,  and  that  no  further  explanation  is  called  for.  If 
this  were  so,  it  would  be  impossible  to  account  for  those 
numerous  cases  in  which  an  ulcer  exists  without  any  such 
delusion.  Manifestly  another  factor  must  be  present,  and 
this  factor  is  disorder  of  the  highest  nerve  regions  or  some 
of  them. 

When,  however,  there  is  disorder  of  the  highest  nerve 
processes,  and  in  addition  there  is  an  alteration  in  the  nutri- 
tion of  the  body,  either  as  a  whole  or  in  some  localized 
position,  then  it  is  highly  probable  that  the  modified 
visceral  nerve  currents  will  so  act  upon  the  disordered  nerve 
regions  as  to  give  a  permanent  bias  to  their  action,  and  then 
it  is  probable  that  on  the  mental  side  the  modification  of 
cdenaesthesis  will  take  the  form  of  a  delusion  of  self. 

Delusions  of  self  thus  arising  are  of  two  forms,  general 
or  local,  according  as  the  modification  of  nutrition  which 
gives  form  to  them  is  general  or  local.  When  the  dis- 
turbance of  nutrition  extends  throughout  the  body,  and  the 
alteration  of  coensesthesis  is  general,  then  the  delusion  will 
have  the  same  character  of  generality,  and  the  patient  Avill 
believe  that  his  total  individuality  is  in  some  way  altered. 
When  the  modification  of  nutrition  is  local,  the  delusion 
will  have  reference  to  the  locality  so  affected. 

Delusions  of  the  whole  self  are  well  classified  by  Professor 
Ribot  into  three  groups.     One  in  which  the  new  self  is  sub- 


368  SANITY   AND   INSANITY. 

stituted  for  the  old  ;  one  in  which  the  new  and  the  old  self 
prevail  alternately  ;  and  the  third  group  including  the 
curious  cases  in  which  the  new  and  the  old  self  exist  side 
by  side,  and  simultaneously. 

To  the  first  group  belong  those  cases  in  which  the  patient 
believes  that  he  is  dead,  that  he  is  possessed  by  a  devil,  that 
he  is  transformed,  that  he  has  no  body,  that  he  is  some  one 
else,  that  he  is  unnatural,  that  he  is  preternaturally  large 
or  small,  hard  or  soft,  that  he  is  a  cat,  a  horse,  a  cow,  a 
sheep,  a  chair,  a  teapot,  or  even  2i  pdte  de  foie  gras. 

Of  the  second  class,  in  which  the  new  individuality 
alternates  with  the  old,  several  cases  have  been  recorded. 
Although  they  are  rare,  they  are  of  so  extraordinary  a 
character  that  they  have  attracted  much  attention,  and  are 
therefore  tolerably  familiar.  After  some  critical  event — 
a  long  sleep,  or  a  convulsive  attack — a  woman  awakes  with 
a  complete  forgetfulness  of  her  whole  past  life  and  with  a 
great  change  in  her  character.  She  lives  for  some  time  in 
this  new  state,  and  then,  after  another  sleep,  she  wakes  with 
a  normal  memory  of  all  the  experiences  of  her  life  before 
her  first  sleep,  and  with  her  former  character  restored  ;  but 
with  a  complete  oblivion  of  everything  that  happened  in  the 
new  state.  Another  sleep  reverses  the  condition  of  things. 
She  has  now  resumed  her  altered  character,  remembers  all 
the  occurrences  of  her  former  new  state,  but  is  completely 
oblivious  of  all  the  occurrences  of  the  rest  of  her  life.  The 
old  state  and  the  new  state  may  alternate  for  an  indefinite 
number  of  times,  the  experiences  of  each  being  remembered, 
and  the  character  appropriate  to  each  being  retained,  only 
in  the  periods  of  its  own  recurrence. 

The  third  general  alteration  of  the  individuality  is  when 
the  old  state  and  the  new  state  subsist  side  by  side.  These 
are  the  cases  of  double  personality — cases  in  which  an  in- 
dividual believes  himself  to  be  two,  and,  as  in  a  case  reported 
by  Dr.  Hack  Tuke,  looks  for  himself  under  the  bed,  or,  as 
in  another  case,  ascribes  his  ill  doings  to  another  self  which 
occupies  the  left  half  of  his  body. 


THE    FORMS   OF    INSANITY.  369 

Local  or  partial  delusions  of  self  are  much  more  common. 
When  the  disturbance  of  nutrition  which  gives  form  to  the 
delusion  is  in  the  skin,  the  patient  imagines  that  his  skin 
is  made  of  velvet  or  of  horn,  or  that  he  is  swarming  with 
vermin,  or  that  he  is  uncleansably  dirty.  If  it  be  in  the 
body  he  may  think  that  he  is  inhabited  by  a  rat,  a  wolf, 
a  dog,  a  cat,  a  weasel,  a  crab  ;  that  he  has  no  inside  ;  that 
he  or  she  is  pregnant  (for  this  delusion  is  by  no  means  con- 
fined to  the  female  sex)  ;  that  his  bowels  are  completely 
stopped,  and  so  forth.  If  the  disturbance  of  nutrition  be  in 
the  limbs,  he  thinks  that  they  are  made  of  glass,  of  brass, 
of  iron,  of  putty  ;  that  they  are  absent,  are  too  large,  too 
small.  If  in  the  head,  his  brains  are  boiling,  they  have  been 
taken  out  and  his  head  is  empty,  or  another  person's  brains 
have  been  substituted  for  his  own  ;  his  head  is  bursting, 
there  is  no  back,  no  top  to  it,  and  so  forth. 


25 


CHAPTER  XV. 

THE    FORMS    OF    INSANITY    (Coutmucd). 

Dementia. 

Simple  dementia  is,  as  we  have  seen,  the  natural  condition 
of  man  in  his  decHning  years.  It  is  a  stage  that  has  to  be 
passed  through  on  the  road  to  death,  if  death  takes  place 
by  the  natural  expiry  of  the  forces  of  life,  and  not  by  violence 
or  by  the  quasi-violence  of  disease.  Normally,  dementia  is  a 
process  of  simple  enfeeblement  and  decadence.  As  the 
bodily  powers  diminish,  the  mental  horizon  contracts. 
Little  by  little,  there  steals  upon  the  organism  an  inability 
to  concern  itself  with  matters  that  are  far  removed  from 
its  own  immediate  welfare.  Little  by  httle,  its  attention 
becomes  more  and  more  concentrated  on  the  things  which 
are  passing  immediately  around  it,  and  which  affect  it  most 
directly.  The  ability  to  deal  with  abstractions  fails,  and 
there  remains  at  last  only  the  vestige  of  the  mental,  as  of 
the  bodily  strength.  In  extreme  old  age — a  period  which, 
as  before  explained,  is  to  be  reckoned,  not  by  years,  but  by 
the  degree  to  which  the  power  of  living  has  ebbed  away — 
the  individual  sits  doubled  up  in  his  chair,  his  head  sunk 
forward  on  his  breast,  his  eyes  staring  straight  before  him, 
his  jaw  dropped,  his  arms  hanging  uselessly  by  his  sides,  his 
hands  resting  inactive,  his  legs  with  the  knees  either  resting 
against  each  other  or  fallen  apart,  his  ankles  bent  sideways, 
and  his  feet  lax.  Speak  to  him,  and  he  answers  only  the 
simplest  questions,  and  not  always  these.  Scarcely  ever 
does  he  initiate  a  remark,  save  perhaps  to  ask  for  food  or 


THE   FORMS   OF    INSANITY.  371 

drink.  He  can  neither  dress  nor  undress  himself.  He  has 
to  be  fed  like  a  child.  Often  he  is  dirty  in  his  habits,  and 
has  to  be  cared  for  like  an  infant.  Such  is  the  end  of  life 
in  every  one  in  whom  life  goes  on  to  the  end. 

Now  it  sometimes  happens  that,  owing  to  the  incidence 
of  some  one  or  more  of  the  stresses  already  considered,  this 
failure  of  energy,  which  is  due  to  occur  at  the  end  of  life, 
sets  in  prematurely.     It  has  been  said  that  old  age  cannot 
be  estimated  altogether  by  years.     If  we  set  a  ball  rolling, 
its  speed  will  not  begin  to  slacken   appreciably  until   the 
impetus  that  we  gave  it  begins  to  be  exhausted  ;  and  the 
stronger  the  initial  impetus,  the  further  the  ball  will  go,  and 
the  longer  it  will  run,  before  it  comes  to  rest.     So  with  the 
living  organism  ;  all  lives  receive  at  conception  an  impetus 
which    is    to   carry   them    forward    to    the    end,    but    the 
impetus  is  not  equally  powerful  in  all,  and  hence  in  some 
it  is  exhausted  at  sixty  or  seventy,  while  in  others  it  suffices 
to  carry  the   organism  over  the  century.     It  may  happen, 
however,  that  owing  to  the  exceptionally  rough  nature  of 
the  ground,  the  velocity  of  the  ball  is  materially  diminished 
at  an  early  stage  in  its  career,  and  that  it  comes  to  rest 
prematurely  ;    and   similarly  it    may  occur   to  the    human 
organism,  that,  owing  to  the  incidence  of  some  stress,  de- 
mentia sets  in  prematurely  ;  and  we  may  have,  in  a  young 
man  or  woman  of  forty-five,  forty,  thirty-five,  or  even  at  an 
earlier  age,  a  state  of  things  precisely  similar  to  that  in  the 
senile  dement.     The  same  enfeeblement  of  body,  the  same 
loss  of  initiative,  the  same  emptiness  of  the  storehouse  of 
energy,  the  same  decadence,  almost  to  the  point  of  absence, 
of  mind,  that  naturally  occur  in  old  age,  may  set  in  in  earlier 
life,  if  the  life  have  been  subject  to  some  severe  drain  upon 
its  energies.     Thus,  it  will  occasionally  happen  that  after 
very  severe  exertion,   either  bodily  or  mental,  undertaken 
by  a  person  who  had  no  very  copious  store  of  energy  to  fall 
back  upon,  he  may  fall  into  a  condition  of  dementia  virtually 
identical  with  the  dementia  of  old  age.     The  chief  and  most 
searching   source  of  exhaustion  of  the  nervous  system  is, 


THE   FORMS   OF    INSANITY.  373 

however,  an  outbreak  of  mania,  and  the  commonest  occasion 
of  premature  dementia  is  an  antecedent  mania.  Every  case 
of  mania  ends  in  dementia.  Doubtless  this  fact  has  another 
aspect,  as  we  shall  presently  see.  From  one  point  of  view 
the  exhaustion  of  the  mania  may  be  looked  on  as  a  cause 
of  the  consequent  dementia  ;  from  another  point  of  view, 
the  mania  may  be  regarded  as  an  incident  or  a  bye-product 
of  the  process  of  dementia  ;  and  both  views  would  be 
correct.  At  present,  however,  we  confine  ourselves  to  the 
first  of  these  aspects. 

It  has  been  said  that  mania  is  the  commonest  antecedent 
of  premature  dementia  ;  it  has  now  to  be  said  that  dementia 
is  an  invariable  consequent  of  mania.  Every  case  of  mania, 
unless  it  is  cut  short  in  its  maniacal  stage  by  physical 
accident,  or  by  the  accident  of  disease,  goes  on  into  dementia. 
The  generality  of  this  statement  will  no  doubt  be  startling 
to  those  who  have  had  experience  in  the  care  of  lunatics,  and 
will  arouse  much  antagonism.  "  What  !  "  they  will  say, 
"  Every  case  of  mania  end  in  dementia  !  Do  not  scores  and 
hundreds  of  cases  of  mania  recover  every  year?  Nonsense." 
To  which  I  reply,  Certainly,  numerous  recoveries  from  mania 
take  place  every  year  ;  but  this  does  not  invalidate  my 
position.  By  dementia  as  ordinarily  understood,  is  meant 
a  permanent  condition,  but  dementia  is  not  necessarily 
permanent.  Doubtless,  the  dementia  of  old  age  is  permanent 
and  progressive  ;  doubtless,  also,  many  cases  of  mania  end  in 
a  dementia  which  is  permanent  ;  but  this  character  of 
permanence  is  not  a  necessary  attribute  of  dementia.  Every 
alienist  of  experience  will  remember  cases  of  mania  which 
have  gone  on  into  dementia,  and  which,  after  a  longer  or 
shorter  period,  have  emerged  again  from  the  dementia  and 
recovered  ;  and,  when  it  is  thus  put  to  them,  I  doubt  not 
that  every  alienist  will  admit  that  every  case  of  mania,  which 
has  recovered  under  his  care,  has  passed  through  a  stage  of 
greater  or  less  mental  enfeeblement  between  the  subsidence 
of  the  maniacal  excitement  and  the  restoration  of  mental 
health.     Of  course  it  may  be  said  that   this  intermediary 


374  SANITY    AND   INSANITY. 

Stage  of  mental  enfeeblement  is  mot  dementia  ;  to  which  I 
reply  that  if  by  dementia  is  meant  a  permanent  condition, 
then,  no  doubt,  it  is  not  dementia.  But  permanence  is  not  a 
necessary  or  invariable  character  of  dementia.  Every  one 
will  admit  that  cases  of  dementia  occasionally  recover.  In 
young  people  recovery  from  dementia  is  not  uncommon.  If 
the  dementia  from  which  such  a  recovery  takes  place  has 
been  consecutive  on  an  attack  of  mania,  then  we  have  the 
type  of  the  sequence  which  is  always  followed  in  recoveries 
from  mania.  In  some  cases  the  consequent  dementia  is 
more  prolonged,  in  others  it  is  more  transient,  in  some 
it  remains  permanent  ;  but  in  every  case,  dementia  of  more 
or  less  duration  is  the  necessary  consequence  of  an  outbreak 
of  mania  ;  and  the  dementia  is  more  or  less  prolonged  and 
profound,  in  proportion  to  the  severity  and  duration  of  the 
outbreak  of  mania. 

Seeing  that  the  pathological  condition  of  dementia  is  an 
emptiness  of  the  storehouse  of  energy — an  exhaustion  of 
the  grey  matter — it  is  evident  that  anything  which  produces 
an  excessive  emptying  of  these  stores  may  produce  dementia. 
That  the  enormous  drafts  that  are  made  upon  them  by  the 
excessive  and  long-continued  activity  of  a  maniacal  outbreak, 
should  produce  this  exhaustion,  is  easily  understood  ;  and  it  is 
equally  clear  that  any  other  source  of  depletion,  if  equally 
prolonged  and  equally  excessive,  will  produce  the  same 
result.  Hence  it  occasionally  happens  that  excessive  study, 
overwork  of  various  kinds,  and  even  very  excessive  physical 
exertion,  brings  about  a  subsidence  into  dementia.  The 
commonest  source  of  excessive  drainage  of  energy  from  the 
nervous  system  is,  however,  undoubtedly  sexual  excess.  It  has 
already  been  shown  how  powerful  is  the  drain  upon  the 
resources  of  the  organism  which  the  sexual  act  involves,  and 
how  much  more  severe  is  this  drain  upon  the  energies  of  the 
male  than  is  that  of  the  sexual  act,  apart  from  the  reproduc- 
tive process,  on  those  of  the  female. 

Hence  it  is  in  males  chiefly  that  are  exhibited  the  ill-conse- 
quences of  excessive  sexual  indulgence  ;  and  in  the  male  sex 


THK    FORMS    OF    INSANITY.  375 

a  very  large  proportion  of  cases  of  dementia  are  either  due  to, 
or  are  aggravated,  enhanced,  and  prolonged,  by  undue  sexual 
indulcrence.  Besides  those  cases  in  which  the  dementia  so 
produced  is  sufficiently  pronounced  to  incapacitate  the 
wretched  individual  for  the  duties  of  life,  and  to  render 
it  necessary  to  commit  him  to  asylum  care,  there  are  an 
enormous  number  of  cases,  forming  together  a  considerable 
proportion  of  the  total  population,  in  which  premature 
decadence  of  the  mental  powers,  premature  exhaustion  of 
the  energies,  premature  inability  for  vigorous  and  active 
exertion,  result  from  excessive  sexual  indulgence  in  early  life. 
The  young  man,  full  of  vigour,  boiling  over,  as  it  were,  with 
energy  and  activity,  recently  let  loose  from  the  restraint  of 
school  or  college,  unaccustomed  to  control  himself  or  to  deny 
himself  any  gratification,  launches  out  into  excesses  which 
at  the  time  appear  to  be  indulged  in  with  impunity.  But 
sooner  or  later  comes  the  day  of  reckoning.  He  has  felt 
himself  possessed  of  abundance  of  energy,  and  he  has  dissi- 
pated it  lavishly,  feeling  that  after  each  wasteful  expenditure 
he  had  more  to  draw  upon  ;  but  he  is  in  the  position  of  a 
spendthrift  who  is  living  on  his  capital.  Had  he  husbanded 
his  resources  and  lived  with  moderation,  the  interest  on  his 
capital  would  have  sufficed  to  keep  him  in  comfort  to  old 
age  ;  but  he  has  lavished  his  capital,  has  lived  a  few  short 
years  in  great  profusion,  and  before  middle  life  he  is  a 
beggar. 

On  the  other  hand,  the  origin  of  the  dementia  maybe,  not 
in  excessive  expenditure  of  energy,  but  in  diminished  activity 
of  the  process  of  storage.  If  from  poverty  of  the  blood,  from 
the  condition  called  anaemia,  the  nervous  system  is  not 
properly  nourished,  it  does  not  receive  into  store  the 
normal  quantity  of  energy.  Its  stores  are  always  much  below 
the  normal  level,  and  hence  less  is  ordinarily  expended ;  and 
if  any  extraordinary  draught  be  made  upon  the  diminished 
store,  the  amount  is  reduced  far  below  the  normal,  and  the 
evidences  of  defective  energy  become  conspicuous.  In  every 
case   of  anaemia,   as  we  have  seen  when  dealing  with  the 


37^  SANITY   AND   INSANITY. 

Stresses  that  help  to  produce  insanity,  there  is  a  certain  mild 
degree  of  dementia.  There  is  a  certain  under-activity  both  of 
mind  and  body,  and  there  is  evidence  that  the  highest 
faculties  of  the  mind  are  especially  deficient.  There  is 
increased  irritability,  showing  deficiency  of  controlling 
power  ;  there  is  loss  of  the  higher  and  better  qualities  of 
feeling  and  of  thought.  There  is,  in  fact,  a  certain  mild 
degree  of  dementia. 

As  to  the  symptoms  of  dementia  pure  and  simple,  there  is 
little  to  add  to  the  description,  already  given,  of  the  natural 
dementia  of  old  age.  The  whole  nervous  system  acts 
sluggishly  and  anergically,  and  its  topmost  strata  are 
altogether  out  of  action.  The  patient  is  slow,  sluggish,  and 
inert.  He  moves  but  little,  undertakes,  in  advanced  cases,  no 
employment  ;  in  less  marked  cases,  employment  only  of  a 
simple  kind.  He  does  not  speak  unless  addressed,  and  then 
answers  not  directly,  but  after  an  interval,  in  monosyllables, 
and  is  relieved  at  being  left  alone.  In  his  mind  the  finer 
and  higher  feelings  are  extinguished.  Affection,  regard  for 
the  feehngs,  comforts,  convenience  of  others,  is  lost.  Nothing 
remains  but  the  appetite  for  food  and  the  desire  for 
tranquillity.  In  advanced  cases,  even  the  former  is  lost. 
Mind  and  conduct  are  alike  reduced  to  the  lowest  denomina- 
tion. Such  are  the  symptoms  of  advanced  cases  ;  but  all 
cases  are  not  advanced.  Often  the  symptoms  are  present  in 
but  slight  degree  and  the  cases  but  mild,  as  in  the  case  of 
ansemia  just  instanced.  There  is,  in  fact,  every  possible  stage 
and  gradation  of  dementia,  from  the  underaction  of  mind  and 
body  which  comes  with  fatigue  at  the  close  of  day,  to  the 
purely  vegetative  existence  of  the  confirmed  dement  who  has  to 
be  dressed,  undressed,  and  fed,  and  who  fails  to  recognize  his 
own  children. 

In  all  the  cases  hitherto  dealt  with,  the  affection  has 
been  a  simple  loss.  There  has  been  diminution  in  the 
amount,  and  degradation  in  the  character,  of  the  activity 
of   mind  and    body  ;    and   that  has    been   all.      But    there 


THE   FORMS   OF    INSANITY.  377 

is  a  large  proportion  of  cases  of  insanity  in  which  this  is  not 
all.  In  every  case  of  insanity  there  is,  it  is  true,  a  degrada- 
tion in  the  character  of  the  activity  of  both  body  and  mind  ; 
but  not  in  every  case  is  there  a  diminution  in  the  amount. 
The  nerve  centres  have,  as  we  have  seen,  three  simultaneous 
and  co-ordinate  functions — the  function  of  initiating,  the 
function  of  controlling,  and  the  function  of  combining  in 
due  proportion  the  activities  of  their  subordinates.  When 
the  centres  are  damaged,  when  their  activity  is  diminished, 
these  three  functions  suffer  of  course  equally  and  simul- 
taneously. It  may  happen  that  the  whole  of  the  hierarchy 
of  the  nerve  centres  is  affected  simultaneously  and  propor- 
tionally, and  in  that  case  initiative  will  be  lost,  from  top  to 
bottom,  simultaneously  and  proportionately  with  control  and 
combining  power  ;  and  the  effect  will  be  that  that  we  have 
just  described,  a  simple  dementia,  uniform  diminution, 
and  degradation  of  activity  of  mind  and  body.  But  it  may 
happen,  on  the  other  hand,  that  the  higher  nerve  centres, 
which  always  receive  the  main  weight  and  incidence  of  the 
damage,  are  affected,  not  only  more  than  the  inferior  centres, 
but  disproportionately  more  ; — that  they  are  severely 
damaged  while  the  inferior  centres  are  comparatively  un- 
affected. In  such  a  case  the  organism  will  lose  those 
activities  which  were  represented  by  the  damaged  highest 
centres,  and  will  be  incapable  of  the  elaborate  and  complex 
activities  which  those  centres  actuated.  It  will,  however, 
retain  the  activities  represented  by  the  rest  of  the  nervous 
system,  and  from  the  removal  of  the  control  which  the 
highest  centres  exercised,  these  lower  activities  will,  if  the 
removal  have  been  rapid,  be  present  in  excess  ;  and,  owing 
to  the  loss  of  the  combining  or  co-ordinating  power  of  the 
highest  centres,  the  lower  ones  will  act,  not  only  excessively, 
but  disorderly. 

It  is  found  in  experience  that  it  is  almost  as  frequent  for 
the  nerve  regions  to  lose  their  functions  in  the  one  of  these 
ways  as  in  the  other.  That  is  to  say,  that  while  the  normal 
course  is  for  the  activity  to  cease  in  all  the  grades  of  nerve 


378  SANITY    AND    INSANITY. 

centres  proportionally,  so  that  there  is  a  uniform  Aveakening 
of  mind  and  body  ;  it  yet  happens  very  often  that  the 
weakening  is  not  quite  uniform  ;  that  the  higher  centres  fail 
not  only  more  than  the  lower,  but  disproportionately  more  ; 
and  that  the  weakening,  while  really  existing  throughout,  is 
conspicuous  only  in  the  working  of  the  higher  regions,  and 
that  the  action  of  the  lower  regions  is  both  in  excess  and 
disorderly. 

It  is  very  often  noticeable  that  old  people,  when  they  have 
reached   such  a  degree  of  dementia  that  they  have  to  be 
looked  after  and  cared  for,  become  not  only  weak  in  mind 
and  inactive  in  body,  exhibit  not  merely  a  loss  of  ability  to 
perform  the  highest  mental  operations  and  to  carry  out  the 
most  elaborate  forms  of  conduct,  but    display  also   certain 
positive  signs  of  disorder  ;  they  become  fretful,  they  become 
irritable  ;   their   tempers    are    less   under  control   than  for- 
merly; little  things  excite  them  to  anger,  and  arouse  a  dis- 
play  of  passion  disproportionate  to   the    offence   received  ; 
they  are  easily  grieved  ;  they  take  again,  after  an  interval 
of  many  years,  to  weeping  ;  and  their  tears  are  elicited  by 
comparatively  insignificant  m.atters.     In  all  these  manifesta- 
tions we  have  evidence  of  loss  of  control.     The  display  of 
emotion,  that   would    normally  be   held   in    check   by  the 
controlling  influence  of  the  highest  nerve  regions,  fails  to  be 
inhibited,  and  occurs  from  the  excitation  of  trifling  causes. 
Thus    the    higher    nerve    regions    are     disproportionately 
weakened,  and  the  lower  are  taking  advantage  of  this  weak- 
ness  to  assert  themselves  with   undue  emphasis.      In  the 
term  "  second  childhood,"  which  is  so  generally  applied  to 
this  state  of  things,  we  see  recognized  the  fact  that  it  is  a 
degradation,  a  reversing  of  the  order  of  evolution,  a  return 
to  a  more  elementary  and  undeveloped  state  of  things.     The 
dotard    who    has    lost    his    highest    controlling   regions    is 
actually  in  much   the   same  condition  as  the  child   whose 
highest  controlling  regions  are  not  yet  developed.     In  each 
case  the  absence  of  the  control  allows  of  a  greater  instability, 
a  more  ready  provocation  to  activity,  than  is  permitted  when 
the  controlling  centres  are  present. 


THE    FORMS   OF    INSANITY.  379 

If  the  overaction  of  the  lower  nerve  regions  is  more 
pronounced,  the  exaggeration  of  conduct  is  more  conspicuous. 
When  the  lower  nerve  regions  are  here  mentioned,  it  is  not 
meant  that  none  of  those  elevated  strata  which  actuate 
conduct  are  left  in  activity.  What  is  meant  is  that  of  these 
highest  regions,  the  highest  of  all,  it  may  be  a  mere  film 
from  the  surface,  is  taken  off;  and  the  disproportionate 
weakening  of  any  higher  region,  however  limited,  allows  of 
overaction  of  those  which  it  is  the  duty  of  that  region  to 
control.  The  conduct,  therefore,  which  is  in  excess,  may  be 
of  a  considerable  height  of  elaboration,  but  yet  is  excessive, 
because  the  region  which  actuates  it,  is  liberated  by  the 
removal  of  a  still  higher  controlling  region. 

The  fretfulness  and  irritability  that  so  often  accompany  the 
dementia  of  old  age,  need  but  a  Httle  exaggeration  to  become 
actual  mania.  If  an  old  dement  begins  to  whimper  because 
his  posset  is  not  ready  at  the  usual  hour,  he  would  be  looked 
on  as  betraying  the  childishness  of  old  age.  If  he  became 
on  the  same  provocation  irritable  and  angry,  and  declared 
that  he  was  neglected  and  nobody  cared  for  him,  he  would 
still  be  looked  on  as  a  childish  old  man,  but  his  aberration 
would  scarcely  exceed  the  normal.  Suppose,  however,  that 
the  conduct  is  somewhat  more  exaggerated.  Suppose  that 
he  screams  aloud  for  his  posset,  and  creates  an  uproar  ; 
suppose  that,  when  his  daughter  brings  it  him  a  few  minutes 
late,  he  assails  her  with  foul  language  ;  suppose  that  he 
proceeds  to  actual  violence,  and  strikes  her,  overwhelming 
her  at  the  same  time  with  low  abuse  ;  in  such  a  case  there 
is  something  more  than  dementia — than  mere  weakening  of 
mind  and  conduct.  There  is  now  overaction  of  lower  forms 
of  activity  left  uncontrolled  by  the  dementia.  Such  an  out- 
break would  very  nearly  amount  to  mania  ;  and  if  it  were  a 
little  more  exaggerated;  or  if,  without  being  more  pronounced, 
such  an  outbreak  were  to  become  frequent ;  or  if,  from 
occurring  upon  slight  provocation,  it  were  to  occur  without 
provocation  ;  then  it  would  amount  to  actual  mania,  and  then 
the  case  would  present  the  usual  characters  of  a  case  of 
"  senile  insanity." 


380  SANITY    AND    INSANITY. 

What  happens  so  often  in  the  dementia  of  old  age  may 
equally  happen  in  the  dementia  which  sets  in,  before  old  age 
is  reached,  by  reason  of  some  stress,  such  as  was  considered 
in  the  last  section.  In  either  case,  if  the  failure  of  the  nerve 
region  takes  place  proportionally,  the  highest  most,  the 
middle  less,  and  the  lowest  least,  then  the  case  is  one  of 
simple  dementia,  senile  or  other  as  may  be.  But  if  the 
highest  nerve  regions,  or  rather  the  highest  strata  of  the 
highest  nerve  regions,  fail  very  much  the  most  ;  the  other 
strata  of  the  highest  regions  but  little  ;  and  the  middle  and 
lowest  regions  scarcely  at  all  ;  then,  not  only  is  the  activity 
of  the  nervous  system,  as  a  whole,  diminished,  but  the  pro- 
portion of  activity  in  the  several  parts  is  disturbed,  and  the 
result  is  that  there  is  an  exaggerated  amount  of  a  low  order 
of  activity. 

Hence  we  see  that  many  cases  of  dementia,  as  already 
noticed,  begin  with  an  outbreak  of  mania.  The  obliterating 
process  that  deletes  the  functions  of  the  nervous  system 
seldom  proceeds  quite  regularly.  It  attacks  the  highest 
regions  first,  and  the  first  sign  of  an  approaching  dementia 
may  be  an  outbreak  of  maniacal  violence.  The  removal  of 
the  control  of  the  highest  regions,  not  only  lets  go  the  region 
beneath  and  allows  it  to  overact,  but  removes,  at  the  same 
time,  that  normal  restraining  influence,  which,  as  we  have 
seen  in  an  early  chapter,  causes  a  centre  to  return  to  rest 
when  the  immediate  provocation  to  action  subsides.  A 
centre  which  is  let  go  in  this  way  tends,  therefore,  not 
merely  to  overact,  but  to  go  on  overacting  until  it  is  com- 
pletely exhausted.  Not  only  does  it  tend  to  exhaust  itself, 
but,  as  it  acts  through  inferior  centres,  it  tends  to  exhaust 
them  also,  and  proportionally  to  its  own  overaction.  Hence, 
while  an  outbreak  of  mania  may  be  the  first  symptom  of  an 
irregularly-invading  dementia,  it  tends  very  powerfully  to 
assist  the  dementing  process,  and  to  make  the  dementia 
regular  and  complete. 

The  amount  of  overaction  that  will  prevail  in  an  outbreak 
of  mania  from  this  cause,  Avill  depend,  not  on  the  quantity  or 


THE    FORMS   OF    INSANITY.  38 1 

depth  of  the  stratum  which  is  peeled  off,  as  it  were,  from  the 
surface  of  the  cortex,  but  in  the  suddenness  with  which  it  is 
removed. 

For  this  reason  we  find  that  if  a  man  slowly  soaks  in  his 
liquor  during  the  whole  of  an  evening,  he  gets  gradually 
more  and  more  stupid,  and  at  last  is  hopelessly  drunk,  with- 
out having  at  any  time  been  uproarious.  But  a  man  Avho 
gets  drunk  by  drinking  off  a  tumbler  of  brandy  for  a  wager, 
gets  uproariously  drunk.  In  the  latter  case,  the  higher  strata 
are  altogether  removed,  and  rapidly  removed,  before  the 
spirit  has  time  to  produce  its  full  effect  on  the  lower  ;  and 
these  latter  are,  therefore,  suddenly  set  free,  and  actuate 
the  uproarious  conduct.  After  a  time,  when  the  lower 
centres  are  reached,  he  subsides  into  stupor,  and  then  into 
coma. 

Hence  we  find  also  that  all  cases  of  very  violent  mania— by 
which  is  meant,  not  necessarily  mania  with  manifestations 
of  violent,  dangerous,  or  homicidal  conduct,  but  mania  in 
which  the  movements  are  very  excessive  and  very  violent — 
arise  very  rapidly.  The  insanity  may  have  been  there 
before  ;  some  amount  of  mania  may  have  existed  before  ; 
but  when  an  attack  of  violent  mania  occurs,  it  always  begins 
rapidly.  It  is  never  led  up  to  by  a  continuously  increasing 
violence  of  conduct.  This,  at  least,  is  always  the  case  in 
ordinary  cases  of  mania,  in  which  the  violence  of  conduct  is 
due  to  overaction  from  loss  of  control.  In  the  rarer  cases, 
in  which  there  is  a  gradually  increasing  violence,  there  is 
always  other  evidence  showing  that  the  overaction  is  due 
not  mainly  to  loss  of  control,  but  to  direct  stimulation  of  the 
nerve  elements,  as  already  explained.  It  is  frequent  in 
cases  of  mania  from  loss  of  control,  for  the  violent  outbreak 
to  be  preceded  by  lesser  outbreaks  ;  and  these  lesser  out- 
breaks may  be  of  increasing  severity;  but  occasional  attacks, 
preceding  a  violent  outbreak,  are  different  from  a  gradually 
increasing  mania  culminating  in  a  violent  outbreak.  It  may 
easily  happen,  and  does  not  unfrequently  happen,  that  an 
occasional  slight   breakdown  of   the   highest  nerve  centres 


382  SANITY   AND   INSANITY. 

takes  place  before  the  main  breakdown.     Under  increasing 
strain  a  bit  gives  way  here,  and  a  bit  gives  way  there,  before, 
at  last,  the  strain  becomes  so  great  that  the  bottom  falls  out. 
The  violence  of  an  outbreak  of  mania  depends,  then,  on 
the  suddenness  with  which  the  higher  centres  are  deprived 
of  their  function.     Different  cases  of  mania  differ  from  one 
another,  however,  in  other  respects  besides  the  violence  of 
the  maniacal  manifestations.     The  variety  in  the  manifesta- 
tions is  almost  infinite.     It  is  a  very  common   supposition 
among  the  laity  that  every  madman  entertains  a  delusion, 
and  the  existence  of  a  delusion  is  regarded  as  the  essence, 
the  criterion,  and   the  test  of  insanity.     It  will  be  apparent 
to  every  reader  who  has  got  thus  far,  that  this  is  by  no  means 
the  case.     In  point  of  fact,  the  lunatics  who  entertain  delu- 
sions  are   in    a    minority,  and   not  a  very   large  minority, 
of  the  whole  number.     In  dementia,  which  is  unquestionable 
insanity — unquestionable  failure  of  the  process  of  adjustment 
of  self   to    surroundings, — there  is  commonly  no  delusion. 
There  is  merely  a  weakening,  degradation,   and  narrowing 
of  mind,  so  that  the  patient  becomes  incompetent  to  manage 
himself  and  his  affairs,  simply  because  he  is  no  longer  able  to 
appreciate  and  understand  his  affairs,  or  to  estimate  truly  his 
own  wants.      In  that  modification  of  dementia,  which  we 
call    mania,    there    may    be    no    delusion.      There    is    still 
weakening,  degradation,  and  narrowing  of  mind,  but  this 
enfeeblement    of    mind  is-  not    accompanied,  as    in    simple 
dementia,  by  a    proportionate   weakening   of   body.      The 
higher  layers  of  the  higher  centres  alone  are  affected.     The 
middle  and  lowest  strata  of  nervous  arrangements  are  intact  ; 
and  hence,  while  conduct  is  disordered,  the  bodily  movements, 
of  which  conduct  is  composed,  are  as  powerful  and  frequent 
as    in    the    normal    state,  or    are,  perhaps,  of  exaggerated 
strength    and  frequency.     The  lunatic    is    still    able  to  get 
about,  to  run,  to  walk,  to  play  cricket,  to  ply  his  trade  ;  but 
the  more  elaborate  nervous  arrangements,  which  actuate  the 
higher  phases  of  his  conduct,  being  disordered,  he  cannot 
effect  these  higher  phases  of  conduct  normally.     It  does  not 


THE   FORMS   OF    INSANITY.  383 

necessarily  follow  that  his  mind  his  distorted  and  his  con- 
duct biassed  by  delusion.  There  may  be  simply  mental 
enfeeblement,  that  is  to  say,  the  higher  processes  of  his  mind 
are  bemuddled.  When  he  attempts  to  think  out  an  elabo- 
rate course  of  conduct,  he  falls  into  a  state  of  confusion. 
When  he  attempts  to  carry  out  an  elaborate  course  of  con- 
duct he  gets  astray  ;  he  does  things  wrong,  he  makes  mis- 
takes, he  fails  to  appreciate  the  force,  and  to  estimate  the 
comparative  value  of  circumstances,  and  his  acts  are  wrongly 
directed,  confused,  and  muddled  ;  but,  throughout  it  all, 
there  is  none  of  that  definite  distortion  of  mind  that  we  call 
delusion.  We  cannot  lay  a  finger  upon  any  one  point  and 
say,  "  This  is  a  delusive  belief ;  that  is  a  delusive  idea."  We 
can  only  find  a  general  state  of  mist  and  fog  and  bemuddle- 
ment.  We  find  vague  expressions  of  confusion,  but  no 
definite,  sharp  cut,  fixed  belief,  that  we  can  call  a  delusion. 
Consider  such  an  utterance  as  the  following,  taken  from  a 
letter  that  I  received  this  morning  : — 

"  Knowing  the  only  chance  to  escape  from  such  awful 
nuisance  for  ages  of  delusions  besides  all  ladies'  honour  con- 
cerned for  upon  that  marriage  of  Lamb  had  depended 
triumph  of  faith  crave  happiness  just  had  been  heartless  way 
preventing  such  deluded  ladies  to  have  such  picture  in  their 
reach  all  cry  shame  were  such  faith  revealed  the  scores  in 
Bible  which  shall  bring  that  marriage  seen  Messiah's  King- 
dom teach  woman's  heart  that  divine  love."  It  is  insane 
enough  ;  but  it  exhibits  no  definite  delusion.  It  is  a  farrago 
of  incoherent  nonsense.  The  erroneous  ideas  that  are  preva- 
lent with  regard  to  the  mental  operations  of  the  insane 
depend  largely,  of  course,  upon  ignorance,  but  largely  also 
upon  want  of  the  dramatic  faculty — want  of  the  capacity  to 
take  upon  oneself,  as  it  were,  another  person's  individuality, 
and  realize  vicariously  their  mental  condition.  The  person 
who  wrote  the  passage  given  above  does  not  entertain  any 
delusion.  The  lower  strata  of  his  highest  nerve  regions  are 
in  good  order.  So  long  as  he  is  dealing  with  concrete  facts 
he  is  not  only  sane,  but  clever.     He  is  a  capable  artizan,  a 


384  SANITY   AND   INSANITY. 

skilful  fly-fisher,  a  good  shot,  a  brilliant  billiard  player,  and 
a  good  chess  player.  For  all  these  concrete  employments 
his  mind  works  well  and  clearly.  But  when  he  tries  to  deal 
v^ith  abstractions  ;  when  he  tries  to  bring  into  operation  the 
highest  faculties  of  his  mind,  the  highest  strata  of  his  brain ; 
he  falls  at  once  into  confusion.  The  truth  is,  that  the  highest 
strata  of  his  brain  are  seriously  and  permanently  damaged, 
and  that,  although  he  can  set  to  work  the  fragmentary 
remains  of  them,  they  can  no  more  turn  out  a  complete  and 
coherent  piece  of  work,  than  can  a  blunted  chisel  cut  a  clean 
groove  in  wood,  or  a  damaged  loom  weave  a  fair  piece  of 
cloth.  With  the  damaged  chisel  you  may  cut  a  groove — of 
a  kind  ;  and  from  the  damaged  loom  you  may  get  cloth — of 
a  sort  ;  and  from  the  damaged  nerve  centres  you  may  get 
conduct — of  some  description.  If  the  defect  in  the  instru- 
ment is  localized  and  definite — if  the  chisel  is  sharp,  but  has 
a  notch  in  it  ;  or  if  the  loom  is  well  constructed,  but  has 
certain  threads  of  warp  missing — then  there  may  be  a 
definite  defect  running  through  all  the  work  that  instrument 
does.  And  similarly  if  the  damage  to  the  highest  nerve 
strata  is  definite  and  localized,  then  there  may  be  a  definite 
delusion  colouring  all  the  operations  of  mind,  and  biassing  all 
the  phases  of  conduct.  But  if  the  chisel  be  merely  blunt, 
without  being  definitely  notched,  the  groove  it  cuts  will  not 
have  a  definite  fault,  but  will  be  generally  rough,  ill-defined, 
and  irregular  ;  and  if  the  loom  be  not'  wanting  as  to  the 
attachments  of  the  warp,  but  be  loosely  and  ill-constructed, 
there  will  be  no  single,  definite  defect  running  throughout, 
but  the  threads  in  the  cloth  will  be  at  irregular  intervals 
instead  of  being  regularly  placed,  and  the  whole  piece  of 
cloth  will  be  defective,  with  a  diffused,  irregular,  general 
defect.  So  if  the  defect  in  the  highest  nerve  regions  is 
diffused  and  general,  the  manifestations  will  be  vague  and 
general. 

The  second  difference  in  the  manifestations  of  mania  will 
therefore,  depend  upon  the  diffusion  or  localization  of  the 
damage  to  the  highest  nerve  regions.    In  the  former  case  the 


THE    FORMS    OF    INSANITY.  385 

mind  will,  in  its  higher  operations  at  least,  be  merely  con- 
fused, and  conduct  will  be  erroneous  in  vague,  unaccount- 
able ways  ;  while  in  the  latter,  mind  will  be  coloured  by  a 
fixed  delusion,  and  conduct  will  err  in  ways  having  reference 
to  that  delusion.  Let  me  again  repeat  that  the  form.er  class 
of  cases  is  much  the  larger,  and  that  lunatics  exhibiting 
definite  delusions  are  a  minority. 

The  characters  of  the  delusions  that  are  entertained  by 
insane  people  are  almost  infinitely  various,  there  being  only 
one  class  of  circumstances  to  which  they  never  refer,  viz.  : — 
circumstances  unconnected  with  the  deluded  person.  In- 
sanity being  disorder  of  the  adjustment  of  self  to  surround- 
ings, it  is  evident  that  delusion,  which  is  a  part  of  insanity, 
must  implicate  self.  There  are  an  almost  infinite  variety  of 
delusions,  but  we  never  find  a  delusion  which  refers  wholly 
to  outside  circumstances,  and  has  no  reference  to  self.  A 
man  will  entertain  the  belief  that  he  is  Emperor  of  China, 
but  he  will  never  entertain  the  belief  that  another  person  is 
Emperor  of  China,  except  he  believe  that  the  person  so 
exalted  gains  by  his  exaltation  a  power  of  interfering  in 
some  way  with  the  deluded  person  himself.  Maclean,  who 
was  tried  for  high  treason  in  1882,  had  a  delusion  that 
almost  everybody  was  dressed  in  blue,  but  he  also  believed 
that  they  dressed  in  this  colour  in  order  to  annoy  him. 

Delusions  fall  naturally  into  three  classes  : — Delusions  of 
self  ;  delusions  of  the  relation  of  self  to  surroundings  ;  and 
delusions  of  the  relation  of  surroundings  to  self.  The  first 
class  we  have  already  dealt  with  ;  the  remaining  classes, 
which  depend  on  alterations  of  the  other  moiety  of  the 
nervous  circulation,  have  also  been  dealt  with  in  part. 

Delusions  of  the  relation  of  self  to  surroundings  vary 
according  as  the  relation  in  which  self  is  supposed  to  stand 
to  surroundings  is  one  of  enhanced  or  diminished  welfare 
and  consequence.  To  the  former  division  belong  the 
delusions  of  power,  of  grandeur,  and  of  wealth,  which 
commonly  accompany  exaltation  of  coenaesthesis  ;  and  to  the 
latter  belong  the  delusions  of  diminished  welfare  and  conse- 

26 


386  SANITY   AND   INSANITY. 

quence,  which  have  been  considered  in  connection  with 
melanchoHa. 

All  the  delusions  of  self  and  of  the  relation  of  self  to 
surroundings  have  this  feature  in  common — that  the  con- 
duct to  w^hich  they  prompt  is  very  rarely  directly  hurtful  to 
others.  They  often  prompt  to  direct  injury  to  self,  and 
to  suicide,  but  only  rarely  to  injury  to  others. 

In  the  third  class  of  delusions  the  alteration  is  in  the 
relation  in  which  circumstances  are  believed  to  stand  to  self. 
The  difference  between  the  delusions  of  this  class  and  those 
of  the  last  is  very  distinct.  In  the  delusions  of  the  class  just 
considered,  the  alteration  is  in  the  way  that  the  self  acts, 
has  acted,  or  may  act  on  his  surroundings.  The  delusions 
of  the  present  class  are  concerned  with  the  way  in  which 
circumstances  act  on  self.  The  peculiarity  of  these  delusions 
is,  that  the  action  of  circumstances,  to  which  the  delusion 
refers,  is  almost  always  considered  to  be  unfavourable. 
Persons  with  delusions  of  this  character  are  the  objects  of 
fancied  machinations  and  conspiracies.  Their  wives  and 
children  are  endeavouring  to  injure  them  ;  people  are 
laughing  at  them,  talking,  whispering,  thinking  about  them. 
People  are  thinking  their  thoughts,  controlling  their 
thoughts,  putting  vile  ideas  into  their  minds  ;  speaking  to 
them,  or  acting  on  them,  or  influencing  their  minds  from 
great  distances,  in  occult  ways,  by  mesmerism,  by  electricity, 
by  telephones,  by  w^ires,  through  the  gas,  the  water,  the 
air,  the  sunlight.  People  are  in  a  conspiracy  against  them. 
Spirits  are  influencing  them,  working  upon  them,  playing 
upon  them.  People  follow  them  about,  point  at  them,  and 
whisper  about  them.  Or  they  are  tormented  by  spirits. 
Horrible  suggestions  and  promptings  are  made  to  them. 
They  hear  voices  or  see  writing  reviling  them,  or  com- 
manding or  suggesting  to  them  to  do  this  or  that.  They 
are  persecuted  ;  the  police  are  after  them  ;  they  are  to  be 
tried,  hanged,  burnt,  boiled  in  oil,  roasted  alive,  starved, 
disembowelled.  They  have  been  robbed,  swindled,  cheated. 
Their  wives  are  unfaithful  ;  their  children,  relatives,  friends, 


THE  FORMS  OF   INSANITY.  387 

acquaintances — the  whole  world  is  in  one  vast  conspiracy  to 
do  them  harm. 

Delusions  of  this  third  class  differ  from  those  of  the  two 
preceding  classes  in  the  fact  that  they  are  very  prone  to 
prompt  to  conduct  that  is  dangerous  to  others.  From  the 
belief  that  one  is  being  injured,  to  the  attempt  to  retaliate 
upon  the  injurer,  is  but  a  very  short  step  ;  and  as  the 
injurious  agency  is  readily  shifted  in  imagination  from  one 
person  to  another,  the  ill  deeds  may  be  ascribed  to  any  one 
whomsoever.  Oftenest  they  are  ascribed  to  relatives,  friends, 
or  acquaintances — to  people  who  have  a  direct  relation  of 
proximity  to  the  patient.  Not  seldom  the  injurious  agency 
is  ascribed  to  some  prominent  personage — to  the  Queen,  the 
Prime  Minister,  to  a  judge  or  a  local  magnate.  Occa- 
sionally the  attempt  at  retaliation  is  made  against  an  entire 
stranger,  one  who  is  unknown  to,  and  has  never  been  seen 
before  by,  the  insane  person.  Lunatics  who  entertain 
delusions  of  this  character  are  never  safe  to  be  at  large. 
The  commission  of  some  deed  of  violence  by  them  is  a 
matter  simply  of  time,  and  sooner  or  later  they  are  sure  to 
become  dangerous.  It  is  not  merely  by  direct  retaliation 
that  such  persons  become  dangerous.  It  is  common  for  them 
to  commit  some  deed  of  violence  on  a  person  in  prominent 
position,  for  the  purpose  of  drawing  attention  to  their 
grievances,  with  the  vague  idea  that,  once  attention  is  drawn 
to  them,  they  will  be  remedied.  Such  persons  have  com- 
monly wearied  out  the  patience  of  their  friends  by  their 
continual  complaints,  which,  at  first  combatted  and  reasoned 
against,  are  at  last  regarded  with  indifference,  and  passed  by 
as  a  matter  of  course.  This  kind  of  demeanour,  towards  a 
person  who  is  subject  to  delusions  of  this  character,  does  not 
answer.  To  him  his  grievances  are  very  real,  and  his 
sufferings  very  painful.  When  he  finds  that  his  complaints 
are  habitually  disregarded  and  ignored,  he  will  seek  some 
method  of  bringing  them  prominently  before  the  public  eye 
and  compelling  attention  to  them.  Commonly  he  has 
carried  his  complaints  before  some  public  official.     He  has 


388  SANITY   AND   INSANITY. 

invoked  the  assistance  of  the  poHce  against  his  persecutors  ; 
if  a  soldier,  he  has  demanded  redress  from  the  commander- 
in-chief.  He  has  appHed  to  minister  after  minister,  official 
after  official,  and  all  his  complaints  have  been  disregarded. 
Not  only  are  his  grievances  not  redressed,  but  they  are  not 
even  inquired  into,  and  he  becomes  exasperated  by  a  double 
sense  of  injury.  As  his  spiritual  foes  cannot  be  reached,  or  as 
all  the  members  of  the  gigantic  conspiracy  against  him 
cannot  be  punished,  he  will  at  any  rate  select  some  one 
whom  he  can  reach,  and  whose  danger  and  injury  will 
compel  the  attention  of  the  community  to  his  intolerable 
grievances.  It  was  on  this  motive  that  the  Queen  was  shot 
at  by  Maclean  ;  that  the  Master  of  the  Rolls  was  shot  at 
by  Dodswell ;  that  President  Carnot  was  shot  at  by  Perrin ; 
and  many  other  instances  will  present  themselves  to  the 
memory  of  my  readers.  I  again  repeat,  that  persons  who 
suffer  from  delusions  of  persecution  can  never  safely  be 
allowed  at  large. 

The  character  of  the  delusions  that  an  insane  person 
entertains,  depends  in  part  upon  the  area  and  nature  of  the 
nervous  strata  which  have  been  removed,  or  rather  upon 
the  character  of  those  which  remain.  Upon  this  factor 
depends  the  determination  of  whether  the  delusion  is  to  be 
one  of  self,  one  of  the  relation  of  self  to  surroundings,  or 
one  of  the  relation  of  surroundings  to  self.  Then  the 
colour  of  the  delusion  —  its  reference  to  increased  or 
diminished  welfare  and  consequence  of  the  individual — 
depends  on  the  condition  of  the  tension  of  the  nervous 
energy  as  high  or  low.  The  general  features  of  the  delusion 
being  thus  determined,  its  individuality  will  be  settled,  in 
part  by  nature  of  the  person  in  whom  it  occurs,  his  history 
and  experience  ;  and  in  part  by  impressions  made  upon  him 
by  passing  events. 

Thus  a  person  who  is  naturally  suspicious  will  have  his 
suspicions  morbidly  exaggerated  ;  a  person  who  is  naturally 
vain  of  the  impressions  he  makes  on  the  opposite  sex  will 
believe  that  he  is  persecuted  by  their  attentions  ;  a  person 


THE   FORMS   OF    INSANITY.  389 

who  is  naturally  religious  will  believe  himself  the  direct 
depositary  of  the  commands  of  the  Deity.  Again,  a  man 
who  has  all  his  life  been  engaged  in  business,  and  whose 
whole  attention  and  energies  have  been  absorbed  in  his 
occupation,  will  have  delusions  in  some  way  referring 
to  it — delusions,  either,  generally,  of  poverty  and  failure, 
or  of  conspiracy  among  his  customers,  or  of  frauds  made 
upon  him,  or  more  particularly  of  the  machinations  of 
business  rivals  and  malign  influences  brought  to  bear 
by  them.  The  uxorious  man  will  believe  his  wife  un- 
faithful  ;  the  mathematician  will  believe,  as  in  a  case  related 
by  Dr.  Clouston,  that  twice  two  are  not  four,  but  four  and 
a  quarter.  The  sportsman  who  suffers  exaltation  will  have 
delusions  of  his  own  prowess,  of  the  range  and  accuracy  of 
his  shooting,  and  the  number  of  head  of  game  that  he  has 
killed. 

The  impressions  made  by  passing  events  will  frequently 
give  colour  to  a  delusion.  In  the  case  of  a  man  who 
believes  that  this  or  that  eminent  person  exercises  influence 
for  good  or  evil  over  him,  the  particular  person  to  whom 
the  influence  will  be  ascribed,  is  the  one  who  is  at  the 
moment  most  prominently  before  the  world.  A  series  of 
political  speeches  reported  in  the  papers  will  lead  to  the 
ascription  of  the  influence  to  the  leading  political  orators. 
A  royal  marriage  will  transfer  the  influence  to  the  bride 
and  bridegroom.  The  sight  of  an  agricultural  engine  will 
colour  the  delusions  so  that  the  indescribable  ill-feelings 
are  ascribed  to  the  action  of  steam.  The  description  of  a 
new  invention  in  the  newspapers  will  determine  delusions 
to  the  telephone,  the  microphone,  the  phonograph,  the 
electric  light  machine,  and  so  forth. 

Important  as  delusions  undoubtedly  are,  as  manifestations 
of  insanity,  let  me,  however,  again  impress  upon  the  reader 
that  the  existence  of  a  delusion  is  by  no  means  of  universal 
or  regular  occurrence,  but  that,  on  the  contrary,  in  the 
majority  of  cases  of  insanity  no  definite  delusion  exists.  In 
the  majority  of  cases  the  condition  of  the  mind  is  one  of 


390  SANITY   AND   INSANITY. 

enfeeblement  or  of  confusion  ;  and  this  condition  of  enfeeble- 
ment  or  confusion  may  extend  throughout  all  the  mental 
operations,  or  may  affect  only  a  restricted  and  elevated 
portion  of  them.  It  may  be  conspicuously  prominent  at 
all  times,  or  it  may  at  some  times  be  imperceptible,  at 
others  elicitable,  and  at  others  manifest.  While  it  is  easy, 
upon  evidence  of  manifest  delusion,  to  come  to  the  conclu- 
sion that  a  person  is  insane,  it  is  extremely  fallacious  and 
dangerous,  from  the  absence  of  such  evidence,  to  conclude 
that  a  person  is  sane.  If  there  has  arisen,  within  any  recent 
period,  prima  facie  reason  to  think  that  a  person  is  insane, 
no  prudent  man  will  venture,  upon  a  single  interview,  to 
pronounce  positively  that  that  opinion  was  not  justified  by 
the  facts. 

With  this  statement  of  the  nature  and  significance  of 
delusion  we  may  terminate  our  review  of  the  facts  of 
insanity.  No  attempt  has  been  made  to  enter  upon  a 
detailed  exposition  of  those  facts,  for,  even  if  the  space 
at  disposal  were  sufficient,  such  an  exposition  in  detail 
would  not  serve  the  purpose  for  which  this  book  is  intended 
— that  of  giving  a  general  view  of  the  facts,  and  a  state- 
ment of  the  laws  to  which  the  facts  conform. 


INDEX. 


Adjustment  of  self  to  surroundings, 
lOI 

Adjustment  of  feelings  to  actions,  io6 
Adjustment  of  thoughts  with  things, 

109 
Adjustment,  disorder  of,  116  et  seq. 
Adverse  circumstances,  254,  266 
Animals  and  vegetables,  difference 

between,  2 
Ansemia,  193,  374 
Anger,  connection  of,  with  insanity, 

lOI 

Appetite  in  melancholia,  344 
Attention,  excessive,  a  cause  of  in- 
sanity, 262 
Automatic  acts,  41 

Blackburn,  L.  J.,  definition  of  in- 
sanity, 97 

Blood,  alterations  in,  cause  of  in- 
sanity, 193,  244 

Blood  supply,  alterations  in,  cause 
of  insanity,  193 

Brain  in  idiocy,  292 

Brewster,  Sir  D.,  case  of  Mrs.  A., 
102 

BrowTie,  Sir  James  Crichton,  on 
disorders  of  nutrition,  135 

Bucknill,  Dr.,  definition  of  insanity, 
97 

Chinese,  suicide  among,  355 


Change,  importance  of,  in  nervous 
action,  328 

Circumstances,   adjustment   of    self 
to,  104 

Circumstances,  influence  of,  a  cause 
of  insanity,  250 

Circumstances,  groups  of,  256 

Climacteric,  242 

,,  disappearance   of    in- 

sanity at,  243 

Clouston,  Dr.,  case  of  insanity,  171 

Coencesthesis,    92,     363,     365  ; 
puberty,  213,  216,  323 

Colour  blindness,  100 

Coma,  312,  320 

Conduct  as  test  of  insanity,  99 

,,         insane,  115;  incorrigibility 
of,  128 

Conformity,  278 

Consanguinity,  156 

Consciousness,  components  of,  63 

,,  difficulty  of  estimat- 

ing, 99 

Consciousness,  effect  on,  of  intensity 
of  experience,  59 

Consciousness,  effect  on,  of  novelty 
of  experience,  56 

Consciousness,  effect  on,  of  tide  of 
nerve  tension,  60 

Consciousness,    correspondence    of, 
with  circumstance,  107 


392 


INDEX. 


Consciousness  of  self,  88 

),  „        disorders  of, 

134 
Consciousness,  relation  of,  to  nerve 

action,  51,  69 
Consciousness,   states  and   changes 

of,  63-66 
Conservatism,  280 
Control,  330 
Cross-breeding,  189 


Damien,  Father,  254 
Definition  of  insanity,  97,  138 
Delirium,    relation  of,  to    insanity, 

191,  201 
Delusions,  103 

,,  absence  of,  in  insanity, 

383,  389 
Delusions,  character  of,  338 
,,  kinds  of,  385 

,,  of  melancholia,  340 

,,  of  persecution,  386 

„  of  self,  364,  366 

Dementia,  369 

,,  accidentalis,  286 

,,  naturalis,  286 

,,  premature,  370 

Digestion  and  melancholia,  323,  343 
Disease,  local,  and  insanity,   248 ; 
of  heart,  93  ;    of  lungs,  93  ;    of 
digestive  organs,  93  ;  of  genito- 
urinary apparatus,  93 
Dodswell,  case  of,  388 
Dreams,  300 
Dress,  222 

Drunkenness,  313,  359 
Drunkenness,  atypical  case  of,  323, 
343 


Ego,  48,  88 
Emotion,  252 

„        a  cause  of  insanity,  253 


Energy,  storage  of,  12 

,,       transmission  of,  10 
Environment,  family,  271 

,,  divisions  of,  256 

,,  importance     of     con- 

sidering, 124 
Environment,  physical,  256 

,,  religious,  281 

,,  social,  276 

,,  vital,  260 

Epilepsy,  petit  vial,  102,  145 
Exaltation,  358 
Eyelids,  mechanism  of  closure  of, 

31 

Eyelids,  closure  of,  as    movement 
and  conduct,  105 


Fabatus,  opinion  on  madmen,  131 
Family,  influence   of,    on   insanity, 

271 
Feeding  in  melancholia,  346 
Feeling,  (id 

,,       adjustment    of,  to  circum- 
stances, 108 
Feeling,    correspondence    of,    with 

circumstances,  107 
Feeling,  insane,  117 

,,       of  well  being,  94 
,,        relation     of,    to     nervous 
action,  51,  69 
Female,    part  of,  in   reproduction, 

237 
Fever  and  insanity,  201,  244,  246 

,,     altered  feeling  of  self  in,  365 
Fit,  hysterical,  228 
Fright  a  cause  of  insanity,  256  et 

seq. 


General  paralysis,  328,  360 
Genius  allied  to  madness,  181 

,,     small  stature  of  men  of,  173, 
174 


INDEX. 


393 


'    Giants,  intellect  of,  173 
Gregarine,  reproduction  in,  234 
G.  S.,  case  of,  128 


Habitual  acts,  41 
Hsemorrhagic  diathesis,  148 
Hair  turning  grey,  135 
Happiness,  physical  conditions  of, 

94 
Heredity,  140 

,,         first  law  of,  143 
,,         second    ,,      156 
Horse,  concept  of,  109 
Hysteria,  213  ^^  seq. 

,,        connection   of,   with    in- 
sanity, 229,  231 


laeger,  case  of  reversion,  164 
Idiocy  from  inbreeding,  161,  171 
,,      induced,  296 
,,      test  of,  288,  290 
Imagination,  70 
Imbecility,  test  of,  287,  290 
Inbreeding,  159 
Inflammation  of  brain,  190 
Inheritance,  144 
Inquisition  in  lunacy,  99 
Insanity,  causes  of,  140  e^  seq. 

,,       connection   of,  with   hys- 
teria, 229 
Insanity,  definition  of,  97,  113,  138 
„       legal,  98-9 
,,       nature  of,  104,  11 3-21 
Insane  conduct,  115 
,,     feeling,  117 
,,     thought,  119 


Life,  prolongation  of,  311 
Livelihood,  means  of,  261 
Local  disease,  248 
Lover,  loss  of,  275 


INIacadam,  281 

Maclean,  case  of,  385 

"  Mad  on  some  point,"  130 

Male,  part  of,  in  reproduction,  237 

Mania,  380 

,,     and  dementia,  372,  378 
Marriage  of  near  kin,  159 

,,        influence  of,  on   insanity, 

273 
Matrix  of  grey  matter,  16 
Melancholia,  336 

,,  appetite  in,  344 

,,  conduct  in,  342 

,,  digestion  in,  343 

Memory,  70 

, ,         conscious  and  unconscious, 

Memory  in  old  age,  305 

Menstruation,  239,  241 

Mercatus,  228 

Migraine,  100 

Mind,  connection  of,  with  nervous 
action,  49,  69 

Mind,  disorder  of,  100 

Movements,  actuation  of,  20 
,,  in  sequence,  23 

,,  mechanism  of,  19 

,,  purposive,  3 

,,  simultaneous,  22 

Mule,  percept  of,  112 

Muscles,  4 


Naudin  on  fertilization,  167 
Nerve  cell,  13 

,,         ,,    origin  of,  18 

,,      centres,  arrangement  of,  25, 

35 

Nerve  centres,  differences  between, 

26 
Nerve  centres,  formation  of,  43 

,,  ,,       relation  of,  with  other 

centres,  27 
Nerve  fibres,  7 


394 


INDEX. 


Nerve  fibres,  extension  of,  17 
Nerves,  ending  of,  in  muscles,  9 
,,       distributors  of  energy,  8 
,,       structure  of,  9,  10 
Nervous  energy,  double  circulation 

of,  39,  89 
Nervous   energy,    influence    of,    on 

nutrition,  29,  ^27^  360 
Nervous  energy,  nature  of,  9 

,,        system,     actuating     move- 
ments, 3 
Nervous  system,  connection  of,  with 

mind,  47 
Nervous  tension,  95,  302,  337,  358 
Novelty  and  consciousness,  56 
Nutrition,  disorder  of,  in  insanity, 
134 


Old  age,  303 
Overwork,  263-6 


Pain,  physical  conditions  of,  92 
Parents,  influence   of,  on   insanity, 

272 
Parry,  Stafif-Surgeon,  135 
Parthenogenesis,  165 
Perception,  73 
Perrin,  case  of,  388 
Personality,  double,  367 
Piorry,  case  of  inheritance,  147 
Poetic  fancy,  85 

,,      mind,  84 
Poverty,  a  cause  of  insanity,  266 
Precariousness  of  livelihood,  269 
Prepotence,  154 
Prosperity,  267 
Puberty,  210 
Punishment  of  insane,  129 


Railway  servants,    insanity  among, 
263 


Rate  of  development,  and  stability, 

176 
Reasoning,  74 

,,         disorder  of,  113,  120 
,,         grades  of,  76-80 
,,         nature  of,  75 
Reflex  acts,  41 

Relations  between  feelings,  67 
Religious  emotion,  220 

,,        environment,  281 
Repetition,  effect  of,  on  conscious- 
ness, 54 
Repetition,    effect    of.    on   nervous 

processes,  17,  41,  72 
Reproduction,  234,  239 
Retirement  from  business,  270 
Reversion,  149 


Savage,  Dr.,  147,  339 
Scientific  mind,  attributes  of,  82 
Sebright,  Sir  J.,  on  inbreeding,  163 
Seduction  a  cause  of  insanity,  276 
Self-consciousness,  88,  224 

„  injury,  353 

„  sacrifice,  220,  354 
Sensori-motor    character    of    nerve 

action,  23,  25,  31 
Sensori-motor    action     in     visceral 

nervous  system,  ;^y 
Sex,  inversion  of,  153 
Sexual  abstinence,  233 

„      indulgence,  233 

,,  ,,  a  cause  of  insan- 

ity, 234 
Sexual  indulgence  in  the  female,  238 
,,  M  ,,      male,  238 

,,  ,,         and  dementia,  373 

Skin,    changes    of    colour    in,    in 

emotion,  136 
Sleep,  299,  344 
Sleeplessness,  205,  344 
Solitude  a  cause  of  insanity,  277 
Somnambulism,  301,  327,  364 


INDEX. 


395 


Starvation  a  cause  of  insanity,  196 

Stress  a  cause  of  insanity,  140,  184 
,,      direct,  184 
,,      indirect,  1S5,  209 

Sucking  the  monkey,  321 

Suicide,  348-357 

Surroundings,    importance   of  esti- 
mating, 122 

Sympathy,  craving  for,  225 

Tension  of  nervous  energy,  95,  302, 

337,  358>  360 
Testamentary  competence,  98 
Test  of  insanity,  98,  99,  125 
Thought,  66 

,,       relation     of,    to    circam- 

stances,  109 


Thought,  relation  of,  to  nervous 
action,  69 

Tuke,  Dr.  Hack,  case  of  double 
personality,  367 

Tuke,  Dr.  Hack,  definition  of 
insanity,  97 

Tuke,  Dr.  Hack,  disorder  of  nutri- 
tion in  insanity,  135 


Wakefulness  in  melancholia,  354 
Will,  48,  84,  85 

Wildness  from  cross-breeding,  179 
Wilks,  Dr.,  cases,  123 

,,  on  overwork,  265 

Winkelreid,  354 


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"  Colonel  Grant  has  performed  his  task  with  diligence,  sound  judgment, 
good  taste,  and  accuracy." — Illustrated  London  Neivs. 

Keats.     By  W.  M.  Rossetti. 

"Valuable  for  the  ample  information  which  it  contains." — Cambridge 
Independent. 

Lessing.     By  T.  AV.  Rolleston. 

"Mr.  Rolleston  has  written  on  Lessing  one  of  the  best  books  of  the 
series  in  which  his  treatise  appears." — Manchester  Guardian. 

Longfellow.     By  Professor  Eric  S.  Robertson. 

"  A  most  readable  little  work." — Liverpool  Mercury. 

Marryat.     By  David  Hannay. 

"  We  have  nothing  but  praise  for  the  manner  in  which  Mr.  Hannay  has 
done  justice  to  him  whom  he  well  calls  'one  of  the  most  brilliant  and  the 
least  fairly  recognised  of  English  novelists.'" — Saturday  Review. 

Milton.     By  Richard  Garnett,  LL.D. 

"  Within  equal  compass  the  life-story  of  the  great  poet  of  Puritanism  has 
never  been  more  charmingly  or  adequately  told." — ScottisJi  Leader. 

Mill.     By  W.  L.  Courtney. 

*'  A  most  sympathetic  and  discriminating  memoir." — Glasgow  Herald. 

Rossetti,  Dante  Gabriel.     By  Joseph  Knight. 

"  Mr.  Knight's  picture  of  the  great  poet  and  painter  is  the  fullest  and 
best  yet  presented  to  the  public." — The  Graphic. 

Schiller.     By  Henry  W.  Nevinson. 

*'  Presents  the  leading  facts  of  the  poet's  life  in  a  neatly  rounded  picture, 
and  gives  an  adequate  critical  estimate  of  each  of  Schiller's  separate  works, 
and  the  effect  of  the  whole  upon  literature." — Scotsman. 

Scott.     By  Professor  Yonge. 

"For  readers  and  lovers  of  the  poems  and  novels  of  Sir  Walter  Scott, 
this  is  a  most  enjoyable  book." — Aberdeen  Free  Press. 

Shelley.     By  William  Sharp. 

"  The  criticisms  .  .  .  entitle  this  capital  monograph  to  be  ranked  with 
the  best  biographies  of  Shelley." — lVest})iinster  Review. 

New  York  :    Scribner  &  Welford. 


8 

Smith,  Adam.     By  R.  B.  Haldane,  M.P. 

"  Written    with  a  perspicuity  seldom  exemplified  when  dealing  with 
economic  science." — Scots?/ian. 

Siiiollet.     By  David  Hannay. 

"  A  capital  record  of  a  writer  who  still  remains  one  of  the  great  masters 
of  the  English  novel." — Saturday  Review. 


Quarto,  cloth  elegant,  gilt  edges,  emblematic  design  on  cover,  $2.25. 
May  also  be  had  in  a  variety  of  Fancy  Bindings. 

THE  MUSIC  OF  THE  POETS: 

A    MUSICIANS'    BIRTHDAY    BOOK. 

Edited  by  Eleonore  D'Esterre  Keeling. 

This  is  a  unique  Birthday  Book.  Against  each  date  are  given  the  names  of 
musicians  whose  birthday  it  is,  together  with  a  verse-quotation  appropriate  to 
the  character  of  their  different  compositions  or  performances.  A  special 
feature  of  the  book  consists  in  the  reproduction  in  fac-simile  of  autographs, 
and  autographic  music,  of  living  composers.  The  selections  of  verse  (from 
before  Chaucer  to  the  present  time)  have  been  made  with  admirable  critical 
insight.  English  verse  is  rich  in  utterances  of  the  poets  about  music,  and 
merely  as  a  volume  of  poetry  about  music  this  book  makes  a  charming 
anthology.  Three  sonnets  by  Mr.  Theodore  Watts,  on  the  "  Fausts  "  of 
Berlioz,  vSchumann,  and  Gounod,  have  been  written  specially  for  this  volume. 
It  is  illustrated  with  designs  of  various  musical  instruments,  etc. ;  autographs 
of  Rubenstein,  Dvorak,  Greig,  Mackenzie,  Villiers  Stanford,  etc.,  etc. 

"To  musical  amateurs  this  will  certainly  prove  the  most 
attractive  birthday  book  ever  published." — Manchester  Guardian. 

"One  of  those  happy  ideas  that  seems  to  have  been  yearning 
for  fulfilment.  .  .  .  The  book  ought  to  have  a  place  on  every 
music  stand."— -IV^/'/'/^/^  Leader. 


New  York  :   Scribner  &  Welford. 


RC601 
Mercier 


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